Quality and Safety

Implementation of MACRA will impact not only physicians, but also the hospitals with whom they partner, the American Hospital Association told Andy Slavitt, acting administrator of CMS, and the U.S. House Ways and Means Subcommittee on Health on Wednesday. Health Subcommittee members met with Slavitt Wednesday on the implementation of the Medicare Access and the CHIP Reauthorization Act of 2015. MACRA's Quality Payment Program, released by CMS on April 27, consolidates a patchwork of programs into two paths for physicians receiving Medicare payments: the Merit-based Incentive Payment Systems (MIPS); and an Advanced Alternative Payment Model (APM). The AHA said it applauds MACRA's streamlining of the physician reporting burden, but still has concerns, especially for smaller practices, and is disappointed the federal government is providing no financial incentives for upfront investments in technology to meet the demands of implementation. The estimated investment is $11.6 million for a small accountable care organization and $26.1 million for a medium ACO, the AHA said. [See also: A deep dive on the 'overwhelmingly complex' MACRA proposed rule.] "Hospitals that employ physicians directly may bear the cost of implementation of an ongoing compliance with the new physician performance reporting requirements under the Merit-based Incentive Payment Systems, as well as be at risk for any payment adjustments," the AHA said in a statement. "Moreover, hospitals may be called upon to participate in alternative payment models so that the physicians with whom they partner can qualify for bonus payments and exemption from MIPS reporting requirements that accompanies the APM 'track.'" House Ways and Means Subcommittee on Health Chairman Pat Tiberi, R-Ohio, asked Slavitt about concerns he's heard about the difficulty smaller practices may have coming into compliance, saying the rural provider, and one or two-person provider group "has a bunch of angst right now." Slavitt said the data shows that smaller and solo practices can succeed as well as physicians in larger-size groups as long as they report. It's up to CMS to make the reporting burden as easy as possible, Slavitt said. "Importantly we are looking for additional steps and ideas as people review the rules, but I will say that we are focusing on technical assistance, providing access to medical home models, opportunities to report in groups and using a reporting process that automatically feeds data, reduces the number of measures and overall lowers the burden for small practices," Slavitt said. Small physicians can report in groups and other physicians may not have to report at all because they're under a minimum threshold for the number of Medicare patients they see, Slavitt said. Slavitt said he's heard from physicians that they want to focus on care, not reporting. Congress has provided funding for MACRA technical assistance to small practices, rural practices and others, he said. MACRA replaces the sustainable growth rate and changes the way physicians and providers are paid, moving the healthcare system closer to CMS's goal of tying 50 percent of Medicare payments to alternative payment models by 2018. CMS is taking comment on the MACRA proposal for 60 days. "Success will come from adopting approaches that are practice-driven," Slavitt said. "It is our intent to align the MIPS and the Advanced APM components of the Quality Payment Program, allowing maximum flexibility for clinicians to switch between MIPS and participation in Advanced APMS based on what works best for them and their patients." To spur motivation, MACRA established an 11-member independent advisory committee, the Physician-Focused Payment Model Technical Advisory Committee, PTAC, that will meet quarterly to review payment models. [See also: A deep dive on the 'overwhelmingly complex' MACRA proposed rule.] The AHA has formed its own clinical advisory group to identify  important policy and operational implications of MIPS and APMS for hospitals. The AHA recommends hospital-based physicians be able to use their hospital's quality reporting and pay-for-performance program to measure performance in MIPS; employ risk adjustment rigorously, including for sociodemographics to ensure providers do not perform poorly simply because they care for more complex patients; and align EHR Incentive Program changes for physicians with those of eligible hospitals. The AHA applauded CMS's proposal to reduce the number of measures for quality reporting from nine to six, and also for its recent work with private insurers and physician groups to reach agreement on a common set of physician quality measures that can be used in both CMS and private payer pay-for-performance programs. "Physicians and hospitals alike spend significant resources reporting on multiple versions of measures assessing the same aspect of care to meet the differing requirements of CMS and individual private payers," the AHA said. The AHA is disappointed CMS has proposed a narrow definition of financial risk in advanced APMs for purposes of MACRA bonus payments, in not recognizing the upfront investment made by providers to implement alternative payment models. The AHA also said fraud and abuse laws need to be modified for a "legal safe zone" where physicians and hospitals can share information Twitter: @SusanJMorse

"With respect to some business practices: It's time to lead, follow or get out of the way," CMS Acting Administrator Andy Slavitt said at the 2016 Health Datapalooza in Washington, D.C. "If you want to lead the way with innovations that help consumers, great; if you want to follow by using established standards for data and measurement and technology, also great," he added. "If you have a business model which relies on silo-ing data, not using standards or not allowing data to follow the needs of patients – pick a new business model or pick a new business." On the heels of the April announcement of the proposed MACRA ruling, Slavitt spoke to healthcare innovators, industry leaders and developers early Tuesday evening. And while he had no further news to share with the specifics of the proposal, it was clear his intentions were firm. "What Vice President Biden said should stick with us: As taxpayers, we did not spend $35 billion so companies could build their own silos," Slavitt said. "At this stage, there's no room for business practices that don’t match the need of patients." On the forefront of Slavitt's thoughts were patients with the least access to care and an "obsession with a plight of the independent physician." However, "physicians are baffled by what feels like the 'physician data paradox.' They're overloaded on data entry and yet rampantly under-informed," Slavitt said. And the majority of providers are seeing a chasm between the time needed to invest in making the IT work and the actual positive results within their practices. "Technology isn’t doing the things we know it can," he added. "Help us make smarter decisions, reduce our wasted time, help us communicate or understand what to expect next." While these issues are troubling, according to Slavitt, the solution isn't the need for more IT inventions. But rather five crucial steps to initiate change in the healthcare industry: the massive release of data; changing incentives to reward providers for patient outcomes; creating "core" quality measures across all payers; advancing interoperability; and the proposed replacement of meaningful use. "These steps are designed to make it easier for you to innovate, to open up competition and to move the focus from designing around regulations, to allowing you to design around patients’ and physicians’ needs," Slavitt said. "The opportunity for you to transform healthcare into an information industry has never been more ripe or more urgent." Twitter: @JessieFDavis Email the writer: jessica.davis@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

By Anna Gorman, Kaiser Health News Lacee Badgley, the mother of a seven-year-old, works full time as an insurance adjuster. Like most working parents, she finds making time for doctor’s appointments a challenge. “I don’t have the time or energy to drive around town and then wait,” she said. That’s why Badgley, 36, switched from her previous doctors to Zoom+, a medical provider and health insurer that aims to give patients more control and transparency. She can make same-day appointments through a mobile app, and she’s usually in and out within 30 minutes. “It’s one-stop shopping,” she said. “I am a big fan of getting everything quickly … I get my medication, my tests, everything in one visit.” Zoom, which serves patients in Portland, Seattle and Vancouver, Washington, is trying to buck the traditional health care system by offering what it bills as convenient, affordable care in a hip and user-friendly environment. The retail clinics, painted a vibrant turquoise, are stylish and simple. The prices are posted on the walls. Zoom was created by doctors Dave Sanders and Albert DiPiero to address problems that have plagued medical care for decades: rising costs, poor service and low quality, Sanders said. “We fundamentally wanted to change the system,” he said. The company targets millennials, who have been at the forefront of change in other industries. Zoom is designed for an imaginary patient named Sarah, who is in her early thirties and wants to get her health care the same way she gets other services in her life — quickly and efficiently. The waiting rooms clearly illustrate that dynamic: There are no magazines because patients don’t typically wait long enough to read. Zoom started as a single clinic in Portland 10 years ago and now has more than 30 locations. Last year, the company expanded in Portland and now offers dental care, mental health services and chronic disease management, as well as appointments with cardiologists, dermatologists and other specialists. It also opened a “performance studio” to help people reach their fitness goals and a clinic that treats emergencies such as broken bones and concussions. This year, Zoom began selling insurance through the Oregon health exchange. Sanders said that by having insurance members of its own, Zoom will be able to better assess its success at controlling expenses and improving care. Only about 2,500 have signed up for Zoom’s insurance, Sanders said. He hopes to expand the insurance arm over time and believes the overall model could be replicated in other cities. In some ways, Zoom is similar to Kaiser Permanente, which also provides medical care and insurance. But Kaiser is a closed system: It only accepts Kaiser members. Zoom is more of a hybrid, treating not only Zoom insurance members but people with other health plans and self-paying patients as well. As a result, the company is both a partner and a competitor to some other insurers. Of course, Kaiser is also a health care giant that operates in multiple states, while Zoom is much smaller and regionally contained. People covered by Zoom insurance can get care at Zoom medical facilities or with Zoom partners, including Oregon Health & Science University hospitals. In recent years, more health care providers have been offering insurance, but the vast majority of them are hospital systems, said Katherine Hempstead, director of coverage for the Robert Wood Johnson Foundation. It’s unique for a network of retail clinics to add an insurance arm, and Zoom’s model is distinct because it is selling a branded experience to a specific population, Hempstead said. One Zoom poster says the complete health system is “designed to make you happier, healthier, smarter, faster, sexier, creativer.” Hempstead said Zoom seems to be betting on the idea that young people are brand-loyal and view health much more broadly. As a result, they may be coming to Zoom not only to see a doctor but also to work with a fitness coach, get therapy or take cooking classes. “It’s a totally new-school approach,” she said. “A company like this is saying, ‘We will be the destination of everything you think of when you want to stay healthy.’ The question is: Will the economics work out?” That could be a challenge given how saturated the Portland insurance market is, said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. And some insurers on the exchange are much more established. In addition, millennials aren’t typically heavy users of the health care system, though many come for regular checkups, she said. Zoom’s success as an insurer depends in part on convincing young people that insurance “is a valuable thing for them to get and maintain,” Corlette said. Attracting young, healthy consumers also helps balance out any older, sicker members. Other health care companies are marketing to millennials also, including New York-based insurer Oscar, which attracts younger consumers with its user-friendly technology. Oscar started selling coverage through Covered California this year. Harken Health, a subsidiary of UnitedHealthcare, assigns members in Chicago and Atlanta to a personal health coach, and — like Zoom — it also offers classes in cooking and yoga. Darcy Hoyt, a veterinarian, said she signed up for Zoom insurance after regularly using the clinics for the past few years. The monthly premiums to cover her and her two children are lower than what her previous insurer charged, and she appreciates knowing in advance how much everything will cost. “So far, so good,” Hoyt said. “For the relatively young, healthy families with kids falling off bikes and getting common colds, it’s very streamlined.” The model appeals to people who want a different approach to medicine that doesn’t have the “vestigial appendices of a health care system that has been around for 50 years,” said John McConnell, director of Oregon Health & Science University’s Center for Health Systems Effectiveness. “It’s like the iPhone,” McConnell said. “Zoom changed the paradigm … The whole way of delivering care is very different.” Zoom is selective about its patient population. While it sees privately insured patients and uninsured ones with the ability to pay, it doesn’t accept people who are on Medicaid or Medicare. By limiting whom they serve, McConnell said, the company’s providers may be cherry-picking the least costly patients and leaving other medical groups and hospitals to deal with medically needier people. Sanders countered that one company can’t be all things to all people and Zoom has decided to invest its resources in serving a population that was ignored by the health system before the Affordable Care Act came along. Zoom keeps costs low by providing care in neighborhood clinics and avoiding unnecessary tests and procedures. It relies heavily on nurse practitioners and physician assistants, and maintains small staffs. It also has its own electronic health record system. “The whole process has been stripped,” Sanders said. “We took out a lot of the people, we took out all the paper, we took out the whole Taj Mahal.” To advance its mission, Zoom has taken on regulators and state policymakers. It successfully lobbied for laws in Oregon allowing nurse practitioners to dispense medication and insurers to reimburse for more telemedicine. The emergency clinic is one place where doctors said they are able to avoid overhead and pass savings along to patients. For patients paying out of pocket, a visit costs under $300. Badgley, who has private insurance, came in to the clinic recently because she had been in bed for days with what she thought was the flu but still felt horrible after returning to work. She only had to explain once why she was there. In the exam room, Dr. Aviva Zigman pulled out a pen and wrote Badgley’s symptoms on an oversized white board, along with the tests she might need and how long the appointment would take. Soon afterward, Zigman quickly determined that Badgley had an ear infection and gave her some antibiotics. Zigman said that as a provider, the Zoom model is much more efficient than a typical emergency room for routine ailments and her patients can get what they need quickly. Another Zoom patient, Amy Cannon, 45, goes to the company’s new primary care clinic for management of her high cholesterol, prediabetes and high blood pressure. The clinic, which has a kitchen in the lobby, offers cooking and yoga classes on site. Cannon said it feels more like a private club than a doctor’s office, and the assistant greets her with a hug. “It’s ‘Cheers’ for health care,” Cannon said. “Everybody knows your name.” This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.    

When Leapfrog released its Spring 2016 patient safety grades recently, 15 hospitals got slapped with a very public 'F' grade casting a spotlight on them that no institution wants. But with more patients weighing public hospital grades, experts, as well as a few hospitals that have faced down bad grades, say denial is the last thing a poorly marked hospital should do. Despite varied methodology among ratings programs, consumers are using these rankings to judge the institutions charged with healing them when they are at their most vulnerable, said Rita Numerof, president of healthcare strategy consulting firm Numerof & Associates. Consumers are also paying far closer attention to these types of rankings because they are shouldering increasingly larger portions of their healthcare costs, and are far more scrutinizing about where they spend those dollars, she said. "As organizations have moved to high deductible health plans and payers have incentivized consumers to go to organizations or have a benefits package that shifts choice to higher value organizations, consumers follow the money, she added. "They've never had this kind of information readily available to them before, and the bottom line is when the consumer is forced to spend more of his or her own money this choice matters." That's great news for those who scored well, but those who didn't make the grade must confront the fallout while fixing the issues that ail them. [See also: Leapfrog out with troubling hospital safety numbers.] Damage control Stony Brook University Hospital, located in Stony Brook, N.Y., was one of 15 hospitals to receive a failing grade from Leapfrog, capping what has been a years-long slide in the rankings. From the fall of 2013 through spring 2015 Stony Brook earned four B's in a row. This past fall it slipped to a C, and then bottomed out in the most recent rankings. The hospital profile on Medicare.gov shows  data to support Stony Brook has issues with patient safety. It has been penalized for the past two years by Medicare for patient safety incidents, and ranked "worse than the national average" on Medicare's Hospital Compare for serious surgical complications, healthcare associated infections, including catheter associated UTI's, and intestinal infections, and several readmission categories as well. According to its website, the New York State Department of Health lists the hospital as high quality performers when it comes to hospital mortality for common conditions and average performers for its rates of hospital-acquired bloodstream and surgical site infections, and timely and effective care. The state lists its patient satisfaction rating as 68.44 percent. However, it was rated as poorly perforning when it came to common patient safety problems, emergency department timeliness, and 30-day hospital-wide unplanned readmissions. Why did Stony Brook perform poorly? Officials responded it was due to errors and misinterpretations on the voluntary portion of the Leapfrog survey, which the hospital took for the first time this year. "Due to a misunderstanding of the Leapfrog survey questions and electronic query processes, several operational and systems measures were given ratings that do not accurately reflect our current practices. This had a significant negative impact on our overall grade," Stony Brook officials said in a statement. "The areas where there was confusion included questions about operational, processes and reporting, not in the clinical outcomes. When the errors in interpretation were discovered and brought to the attention of Leapfrog, they advised that the review period had closed and the data could not be corrected and grade could not be changed," They did not address other questions with regard to some of the publicly available data that support's Leapfrog's grade, or whether they thought the alleged survey errors were the only reason for the poor grade. They also did not specify any measures currently underway to improve patient safety. Leapfrog said that while they had been in contact with Stony Brook over the survey issues, there may have been other issues at play. According to Missy Danforth, vice president of hospital ratings for Leapfrog, Stony Brook reviewed its survey results and the CEO explained there were practices the hospital is compliant with that his staff didn't know about and did not report on. Leapfrog said they encouraged them to take a different approach to completing the survey "as it is really a gap if there are policies and practices the CEO knows about that the front-line staff and senior managers are not aware of, particularly if they are related to patient safety." Leapfrog said Stony Brook informed them they are committed to improving this process for next year and that they are "working hard on many fronts related to patient safety." [See also: Leapfrog: Hospitals still falling short on maternity care.] However, Leapfrog also asserted that the errors could have been avoided if their review process had been followed appropriately. They explained that Leapfrog gives hospitals technical support through a help desk and hospitals have opportunities to review their submitted responses and make corrections while the survey is open. The survey is open from April 1 - January 31 of each year.  After the survey closes, no changes can be made. "We publicize our deadlines and make clear how our measures are scored. We also have a CEO attestation of accuracy that every CEO must sign off on, or designate a delegate to sign off on, for each submitted section of the Leapfrog survey. This hospital submitted their 2015 survey on December 22nd, and their results were publicly reported on our website on January 5th. We encourage all hospitals to review their publicly reported results to check for data inaccuracies. If the hospital had noticed discrepancies in reviewing their publicly reported results, they could have updated their survey at any point throughout the month of January prior to the survey closing." Whether the survey errors were the major culprit or not, the fact that they offered no other explanation coupled with existing public data, which doesn't paint an entirely flattering picture of the institution, casts doubt on the true significance of the survey issue and moreover plants a seed of doubt in the public's eyes, said Numeroff. "The worst approach is blame, denial or rationalizing away the numbers. Even if you don't like the measures, and there's lots of complexity behind the measures and they're far from perfect, knowing that you still have to perform against them. Taking this as a wake-up call and a lesson and recognizing that there is work to be done would be really helpful. You have to get your own house in order and to do that acknowledging mistakes is a starting point," Numerof said. Other hospitals who received F's didn't delve into enormous detail, but were willing to admit there were things they needed to do better. For Clarion Hospital, a small facility in Pennsylvania, this is the fourth failing grade they've gotten from Leapfrog, and they haven't scored better than a D since fall of 2013. They said there were not surprised that this spring brought their 4th 'F', but stress that they have been making improvements and are committed to patient safety. "Patient Safety is very important to us here at Clarion Hospital.  We are aware that our score is below average and have developed internal processes to make the necessary improvements.  It is our mission to improve our Leapfrog grade within the next quarter," said CEO Byron Quinton. They said their rates of hospital-acquired infections, patient harm incidents and avoidable deaths are all in line with state averages, and cited outdated data as a potential contributor to their poor grade. "We are small community hospital and have lower numbers in comparison to many hospitals. The timeframe for the data, in some cases is greater than 3 years old and has not been updated, which reflects poorly on us even as improvements have been made," Clarion said in a statement. Saint Michael's Medical Center in Newark, New Jersey also doesn't have a history of high scores to refute their current 'F'. Four straight D's in a row starting in fall of 2013 were followed by a peak C in Fall of 2015. Then came the bottom this spring. They did not participate in the actual survey portion and said based on public data their performance is on par with state averages, so the failing grade was a surprise. According to Medicare.gov, St. Michael's is rated as a two-star hospital and is on par with national benchmark's when it comes to complications, and most readmissions/deaths categories except for unplanned readmissions for heart failure patients, where it was scored worse than the national average. While St. Michael's Chief Medical Officer Claudia Komer also pointed in part to outdated data as having influenced their grade, it was not a flat-out denial, and stressed that the issues they do have are being addressed. "The publicly reported data for two key areas used in the Leapfrog report, central line-associated bloodstream infection and catheter-associated urinary tract infections does show higher than average rates for the reporting period from April 2014 to March 2015.  The hospital, however, having already identified the issue, developed a corrective plan of action to reduce both types of infections. We are happy to report that in the first quarter of 2016, we had zero CLABSI and CAUTI infections." She said they have also addressed another shortcoming, the lack of a computerized physician order entry system. They said they received a zero in this category, but have since implemented such a new system. Finally, Komer said the hospital is under new ownership, having been acquired by Prime Healthcare in early May. She said the new parent company will open doors to better patient care for their hospital, and in the future they will definitely participate in the Leapfrog survey. "Prime brings extensive resources to Saint Michael's that the hospital just didn't have before, including the sharing of best practices with other Prime hospitals nationally. Prime also has a stringent internal quality reporting process and each hospital is held accountable to those standards. Saint Michael's will have the resources to achieve an entirely new level of intense focus on patient quality and safety. It's what our patients deserve." [Also: Leapfrog: 798 hospitals earn A scores for patient safety; See the list] Turnaround stories For Van Wert County Hospital in Van Wert, Ohio, the fall of 2014 and the spring of 2015 were bad months. The 70 bed nonprofit in northwestern Ohio received two failing grades in a row from the Leapfrog Group for patient safety, and staff there felt like they had been blindsided, having been under the impression that they provided safe and quality care. It was a bad assumption, Interim president and CEO Mike Holliday said, that had bred a culture of disconnect. "We really didn't have that top-down focus because everyone assumed that we didn't have those kinds of issues. Once the information came out from Leapfrog, that hit us in the face and made us stand up and take notice," Holliday said. His plan: fess up. There was no blaming their grades on survey errors or old data, Holliday said. They simply owned up to their problems. "We took it at face value that it is what it is. It's not a very pleasant situation to find ourselves in. We had some work to do and we were going to roll up our sleeves and address those issues," he said. Holliday said they got senior leadership involved from the start, and over time, invested in several programs that would help them discover where the issues were. They also instituted measures that brought staff closer together and opened the lines of communication wider than they had ever been. He said they sought education opportunities on how to improve their culture of patient safety, and put time and financial resources into the National Database on Nursing Quality Indicators program. The program's survey was provided to staff on a quarterly basis and the results helped steer their course in making needed improvements. Holliday said they fostered teamwork and communication through the implementation of daily patient safety huddles, where every morning staff got together to review safety protocols and identify opportunities for improvement. These huddles happened at the management and executive levels as well, with senior leadership meeting daily to review the past 24 hours of activity for needed improvements and look ahead to what might come up in the next 24 hours. "We can't fix issues if we don't know about them. So it gives staff an opportunity to raise those issues, raise those concerns and red flags and then give management the opportunity to address them in a positive educational learning process. It also helps make staff more comfortable with reporting those issues and then we can show that there's no negative culture about it." Finally, to fix safety issues related to medications, pharmacists became part of rounding. They went with physicians, nurses and other staff as they met with patients to allow the pharmacist to communicate with the patient about their medication and also follow up with nurses and physicians on any issues. Holliday said the turnaround happened faster than expected, and the 'A' they earned this spring was a much appreciated validation of all their effort. But it wouldn't have been possible if they had instead chosen to close ranks, deny they had issues, and opt for tight-lipped damage control to the public and the media. "The benefit was to show the community we serve that we're transparent, that we're very serious about these issues, and that we know that they're depending on us as they're giving themselves up to us to help them through their medical conditions. It gave us the opportunity to re-earn their trust. Had we approached it differently we would have been subject to a lot of skepticism within the community and the potential of more negative press." Wayne Memorial Hospital in rural Jesup, Georgia, also earned an F in fall 2014 rankings from Leapfrog, and it hit staff hard. "We were devastated and our first focus was to find out where we could do better," said Kathy Buchannan, chief nursing officer. The small 84-bed nonprofit facility had just lost two long-time trusted surgeons, and had been going through a difficult transition as replacements who Buchannan said lacked a focus on patient safety came and went. "We felt like that was our weak link at the time," she said. She also explained staff communication was a problem. But since they had close relationships with the members of their small rural community, denial wasn't an option for them either. "It was in the newspaper. I remember when we got the F. We get a lot of the same patients because it is a small community. Some people didn't believe the F. But we told people we are better than that. We are working on it. So community members were aware of of it but were understanding," Buchannan said. Buchannan and Lisa Boatright, Wayne's director of quality management, both said that many problems were solved once the revolving door of surgeons stopped turning and they were able to finally put in place a team that was the right fit and had the right focus, patient safety. They also took communication and accountability to a much higher level. Boatright said physicians started bridging the gap between them and nurses by having educational conversations about procedures with them. Boatright said this improved the rapport between the two groups and made everyone more comfortable, especially new nurses who Buchannan said can often be timid about reaching out to doctors when they need help. They also instituted an open door, anonymous reporting system whereby staff could contact supervisors or hospital leadership through a variety of channels to report concerns or problems. "If people saw something they thought was unsafe they could report it anonymously. They could come into my office, call or just write it down. Names wouldn't be mentioned so they felt comfortable voicing concerns," Boatright said. Finally, they brought patients into the process by interviewing everyone that came in for treatment about their experience. Boatright and Buchannan said they would generally wait until the second or third day of their stay, but everyone was given the opportunity to provide feedback and voice issues they had with their care before they left the hospital. Even though these may not seem like huge steps to take, for a small rural hospital they made all the difference. In fact, earning an 'A' from Leapfrog this Spring wasn't even the biggest pay-off. In 2015, Wayne Memorial Hospital won the Small Hospital of the Year award from the Georgia Hospital Association. No small feat for a small facility that just a year prior was in turmoil. Buchannan said collaboration and commitment to change from all levels was key. "It just let us know what kind of ownership our staff had of our facility. It made us happy to know that and also that so many people wanted to help make it better." Twitter: @BethJSanborn    

New findings from hospital watchdog the Leapfrog Group shows many hospitals across the country are failing to meet national performance targets for  quality of maternity care. The study comes on the heels of Leapfrog's twice-yearly Hospital Safety Score, which assigns letter grades to hospitals based on their adherence to various safety standards. According to the report, 798 hospitals earned an 'A,' 639 earned a 'B,' 957 earned a 'C,' 1162 earned a 'D' and only 15 earned an 'F,' [See also: Leapfrog out with troubling hospital safety numbers.] When it comes to maternity care, facilities were deficient in a number of different areas, such as the rate of episiotomies. A once-routine incision made in the birth canal during childbirth, it's now recommended only in a very narrow set of cases; Leapfrog's target for all hospitals is to perform the incision in 5 percent or less of all cases. Yet the rates were too high among 68 percent of hospitals. Too many C-sections were also being performed, the data showed. At 60 percent of reporting hospitals, the rates surpassed Leapfrog's target rate of 23.9 percent for all hospitals, and the variation was dramatic -- ranging from as low as 10 percent to as high as 54 percent in one unidentified east coast city. Not all of the findings were dour. Four out of five hospitals meet Leapfrog's target of 5 percent for early elective deliveries, which are medically unnecessary inductions or C-sections performed at 39 weeks. That, the report said, means the facility is taking steps to minimize risks to the mother and child be delivering too soon. [See also: Leapfrog Group: Rate of serious, even fatal, hospital infections still too high.] Additionally, the early elective delivery rate has shrunk dramatically, with the national average at 2.8 percent, compared to the 17 percent reported in 2010. But the study also shows many hospitals don't have adequate experience with high-risk deliveries. Low-weight infants born with complications are more likely to survive if the hospital has an experienced neonatal intensive care unit on-site, yet 78 percent of hospitals performing high-risk deliveries don't meet the Leapfrog standard. "This report underscores the importance of understanding the risks associated with specific delivery choices and of improving the quality of care during birth for the wellbeing of both mothers and their babies," said Kristin Torres Mowat, senior vice president of plan development and data operations at Castlight Health, in a statement.

As the country celebrates National Women’s Heath Week this week, women at the University of California, San Francisco’s National Center of Excellence in Women’s Health, have double cause to celebrate. It was 20 years ago the center was founded. The founding director, Nancy Milliken, continues to lead the enterprise today. “Women were vulnerable to harm from undertreatment, overtreatment and mistreatment due to the lack of rigorous research on women's unique experience of health and disease,” Milliken said in the May 8 UCSF article. Before launching the center, Milliken was a professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at UCSF. UCSF was designated in 1996 as one of the nation's first six National Centers of Excellence in Women's Health, sponsored by the Office on Women's Health in the U.S. Department of Health and Human Services. The quest has always been for health equity. “My dream would be that the need for UCSF National Center of Excellence in Women’s Health would be eliminated because sex and gender approaches to research, clinical care, education are in the DNA of UCSF, and inform health care and policy across our nation and the world,” Milliken said in the UCSF article. The other five National Centers of Excellence in Women’s Health designated by HHS in 1996 are located at: – Allegheny University of the Health Sciences, Philadelphia – Magee-Womens Hospital, Pittsburgh – Ohio State University Medical Center, Columbus, Ohio – University of Pennsylvania, Philadelphia – Yale University, New Haven, Conn. Read the article here. Twitter: @Bernie_HITN Email the writer: bernie.monegain@himssmedia.com  

The federal government paid bonuses to 231 hospitals with subpar quality because their patients tend to be less expensive for Medicare, new research shows. The bonuses are small, generally a fraction of a percent of their Medicare payments. Nonetheless, rewarding hospitals of mediocre quality was hardly the stated goal when the Affordable Care Act created financial incentives to encourage better medical care from hospitals, doctors and other health care providers. A study published Monday in the journal Health Affairs looked at the more than $1 billion in payments made last year in the Hospital Value-Based Purchasing program, which raises or lowers Medicare payments to hospitals based on the government’s assessment of their quality. Medicare primarily uses death and infection rates and patient surveys to judge hospitals, but it also evaluates how much each hospitals’ patients cost, both in treatment and recovery. The 231 hospitals the study identified had below average scores on quality measures but were awarded the bonuses because caring for their patients during their stays and in the 30 days following their discharge cost Medicare less than what it cost at half of hospitals evaluated in the program. The Centers for Medicare & Medicaid Services, or CMS, began measuring cost in October 2014 to encourage hospitals to provide care in the most efficient way possible. In the period examined in the study — the federal fiscal year that ended in September 2015 — spending counted for 20 percent of a hospital’s score in determining whether a hospital would get a bonus, penalty or regular payment. Under this formula, hospitals with Medicare spending below the median hospital were able to qualify for bonuses even though their quality measures were below the median, the study found. Patients at those 231 hospitals cost Medicare on average nearly $16,000, about $2,300 less than the average spending for the patients at other hospitals that received bonuses, according to the study’s lead author, Anup Das, a medical and health policy student at the University of Michigan. The average bonus for those lower quality hospitals was an 0.18 percent increase in Medicare payments for each patient stay during that fiscal year. Most of the 1,700 hospitals that received a bonus that year had higher than average quality ratings, and their patients in some cases were more costly to Medicare. [See also: 15 quality chiefs at best hospitals.] “High-quality low-spending hospitals received the greatest financial benefit from the program,” the study said. “In this respect, CMS achieved its goal with the new spending measure. However, some low-quality hospitals received bonuses because of their low spending.” In a statement, CMS said it would consider revising the program for future years so that hospitals scoring below the national median for quality would not receive a bonus. The statement also noted that this year, three-fourths of hospitals’ scores were based on quality measures. “We believe that there needs to be a balanced consideration between quality and cost, which is reflected in our scoring methodology,” the statement said. The study found the lower-quality hospitals that received bonuses in the last fiscal year had higher death rates for heart attacks, heart failure and pneumonia than half of the nation’s other hospitals evaluated in the program. These hospitals were also less likely to follow recommended procedures for care, like choosing the right antibiotic for patients or performing an angioplasty on a heart attack patient within 90 minutes of their arrival at the hospital. [See also: 1,700 hospitals win Medicare quality bonuses, but will never collect.] The 231 lower-quality hospitals with bonuses also received less enthusiastic ratings from patients about how well doctors and nurses communicated, responded to issues and managed pain, the study found. The study did not name the 231 hospitals. “It’s a small decrease in quality, but the differences are significant,” Das said in an interview. Other new federal quality payment programs created by the health law, such as accountable care organizations, deny bonuses to doctors or hospitals with substandard quality of care, no matter how efficiently they operate. The study suggested the government add a similar limitation to the Value-Based Purchasing program. The study did not look at the current federal fiscal year, which runs through this September. This year, Medicare gave bonuses to 1,705 hospitals, averaging 0.51 percent, and reduced payments to 1,375 hospitals by an average of 0.34 percent, according to a Kaiser Health News analysis. Along with spending, Medicare’s other criteria are: death and infection rates; how faithfully a hospital followed basic clinical guidelines; and how patients rated their experiences in surveys. Spending counts for a fourth of each hospitals’ scores, more than last year, and is scheduled to continue to do so for the next two years. The study’s lead author, Das, said in the interview that a preliminary analysis found some lower-quality hospitals again received bonuses.  

McKesson and Blue Cross Blue Shield of Arizona are partnering to create a new service that helps physician practices that may not be part of a value-based network take on risk as traditional accountable care organizations do. The service, dubbed ACO Partner, is not an accountable care organization. But don't call it a product either, said John Wallace, ACO Partner's new president and chief operating officer. Wallace is McKesson's national vice president and general manager of accountable care services. "It's more of support structure," Wallace said, for the physician practices and providers that need help making the transition to performance reimbursement. It works like this: Physicians and providers sign a shared savings contract with a health plan participating within ACO Partner. Through the services provided, the practice reduces its expenses in medical claims in general, and a percentage of that savings goes back to the provider and insurer, according to Wallace. There is no cost to practices, so they share in the savings without risking payment cuts. "We're making the bet to say, 'Let's do it for them.' We're taking on the responsibility of analytics," Wallace said. So far, only Blue Cross Blue Shield of Arizona has signed on. [See also: McKesson launches venture capital fund.] ACO Partner in marketed to independent physicians who may not have the resources to transition to value-based care, and also to ACOs and clinically integrated networks that may need help accelerating the transition to getting paid for high quality and cost effective healthcare. "Better benefits for lower costs," Wallace said. "It allows them to take more market share, to compete at a higher level." McKesson provides the technology infrastructure and the analytics to support payers as they collaborate with the provider networks. ACO Partner claims to help physicians with the practical components of value-based care, including disease management, care management, population health management and patient engagement. Providers and payers contracting with ACO Partner have access to  strategic management, analytics, population health, technology, network development, physician engagement and care management services. "A lot of ACOs are making heavy investments in services and technology without a clear roadmap for success," Wallace said. A year from now, Wallace wants ACO Partner to have three to five health plans participating in state of Arizona. Beyond Arizona, he envisions the model in multiple other states. For patients, the new entity is intended to strengthen outcomes while helping reduce out-of-pocket expenses, Wallace said. "Providers love it because they have a better patient experience," Wallace said. "Plans love it because they're seeing a higher quality of care delivered. And it extends to a more efficient cost structure." Twitter: @SusanJMorse

As physicians study the Merit-based Incentive Payment System and Advanced Alternative Payment Models outlined in the newly proposed MACRA rule, the Centers for Medicare and Medicaid Services has released its finalized Quality Measure Development Plan in support of the new payment structure.

In response to the ongoing water crisis in Flint, Michigan, Google.org, the company's charitable arm, is donating $250,000 to provide technical resources to help resolve the water issues now and in the future.