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By Michael D. Williamson
Dec. 1 — Medicare's hospital quality efforts have reduced program costs by nearly $20 billion and saved 87,000 lives, according to a federal report released Dec. 1.
The draft report from the Department of Health and Human Services' Agency for Healthcare Research and Quality focused on a program designed to reduce the number of hospital-acquired conditions (HACs). Andy Slavitt, the acting Centers for Medicare & Medicaid Services administrator, announced the results of the report at the CMS Quality Conference in Baltimore.
At the conference, acting CMS Principal Deputy Administrator Patrick Conway announced that the agency awarded $110 million in funding for the end-stage renal disease (ESRD) care improvements. Conway is also the deputy administrator for innovation and quality at the CMS and serves as the agency's chief medical officer.
A cumulative total of 2.1 million fewer HACs were experienced by hospital patients in 2011, 2012, 2013 and 2014 relative to the number of HACs that would have occurred if rates had remained steady at the 2010 level, which in turn drove down Medicare's costs and saved lives, the report found.
A Dec. 1 statement from the HHS said HACs include adverse drug events, catheter-associated urinary tract infections, central-line-associated bloodstream infections, pressure ulcers and surgical site infections, among others.
One likely cause for the progress was that the CMS created financial penalties for hospitals with higher HAC rates, the report said. However, the reasons for progress on reducing HACs aren't fully understood, according to the report.
In addition to the financial penalties, the report cited public reporting of hospital-level results, technical assistance offered by the Quality Improvement Organization program to hospitals “and technical assistance and catalytic efforts” of the HHS Partnership for Patients (PfP) initiative led by the CMS.
A QIO is a group of health quality experts, clinicians and consumers organized to improve the care delivered to people in Medicare. Part of the mission for QIOs is protecting the Medicare trust fund by ensuring that the program pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting.
The HHS announced the PfP in April 2011 (71 HCDR, 4/13/11). At that time, the HHS said the program will bring together stakeholders including hospitals, employers, consumer advocates, health insurers and others to meet two primary goals by the end of 2013: reduce preventable HACs by 40 percent and reduce preventable hospital readmissions by 20 percent, compared with 2010 levels.
According to the report, the widespread implementation and improved use of electronic health records at hospitals likely contributed to the HAC reduction as well.
Following Conway's ESRD announcement, the CMS published a blog posting authored by the deputy administrator with further details on the dialysis funding.
In the blog posting, Conway said the CMS awarded $110 million to fund seven entities within the 18 various ESRD networks. A congressional mandate created the networks in 1978 as a way to improve cost effectiveness, ensure quality of care, encourage kidney transplantation and home dialysis and offer assistance to ESRD beneficiaries and providers. According to Conway's blog posting, ESRD beneficiaries make up less than 1 percent of the Medicare population, but account for 7.1 percent of Medicare program spending.
“These seven entities will work over a five year contract period, 2016 – 2020, to continue efforts in improving quality of care and access to care for individuals with irreversible kidney disease who require dialysis or transplantation to sustain life,” Conway said. Moreover, ESRD networks’ quality improvement activities will incorporate efforts to impact the patient population by increasing pneumococcal and hepatitis B vaccination rates in dialysis patients, reducing the use of long-term catheters for vascular access and reducing hospital-acquired infections, Conway said. Additionally, he said the ESRD networks will work on pilot projects to increase transplant referrals, increase home dialysis rates, improve quality of life and reduce hospitalizations for people with ESRD.
During the 2013 through 2016 ESRD network contract cycle, ESRD networks have seen great successes, according to the blog posting. “These successes included leadership in Patient and Family Engagement through learning and action network activities. Additionally, ESRD Networks have moved arteriovenous fistula (AVF) vascular access use to above 60 percent nationally,” Conway said.
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