Quality Improvement

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Stage 2 Guide for EHR Incentive Programs Now Available

HHS Launches Meaningful Consent Online Resource

Avoid a -1.0% Medicare Payment Claims Adjustment in 2015

Three Quality and Patient Safety Articles Added to the Member-Only Resource Library:

  1. Making HealthCare Safer II
  2. Top Patient Strategies
  3. AHRQ Research Activities Findings and Reports

The Near Miss Registry is sponsored by the American College of Physicians and the New York Chapter of the American College of Physicians. The Registry permits healthcare workers to voluntarily report medical "near miss" events” in a web based tool.

 

Did You Know?

In 2012, the ACP Center for Quality was designated as a Patient Safety Organization (PSO) by the Agency for Healthcare Research and Quality (AHRQ) on behalf of the U.S. Department of Health and Human Services.

What is Quality?


The Institute of Medicine defines Quality as “the extent to which health services provided to individuals and patient populations improve desired health outcomes. Quality care is safe, effective, patient centered, efficient and equitable.  Quality Health Care is based on the strongest clinical evidence, provided in a technically and culturally competent manner, with clinicians using effective communication skills and engaging patients in shared decision making.”

NYACP Quality Improvement

As the largest medical-specialty organization in New York State, the Chapter's quality priorities focus on providing members with tools, resources and education to help guide them on delivering the best possible care to their patients and alert members to healthcare quality trends and initiatives.

NYACP Quality and Patient Safety Committee Mission

The mission of the NYACP Quality and Patient Safety Committee is to educate members on quality trends and initiatives, to guide the Chapter in quality project and improvement activities, and to provide members with resources and tools for incorporating quality improvement, patient safety and outcomes initiatives into their practice.

This includes:

  • Serving as an educational resource for NYACP members.
  • Serving as the central forum for linking all quality initiatives within the Chapter.
  • Communicating with Council and membership regarding ongoing quality and patient safety initiatives.
  • Participating in quality and patient safety project development and decision making with other partners.
  • Serving as a physician advocate and resource for evaluation of quality and patient safety measurement programs.
  • Evaluating possible new quality and patient safety initiatives and requests for Chapter support, and make recommendations to the Executive Committee.

Latest News:


Buyer Beware - An Important Message from MLMIC


Recent information indicates that there are now over 40 insurers competing for medical liability insurance in NYS. Sometimes, either through investigation or by chance, it is discovered that premium quotes can appear too good to be true.

Possible reasons might be that insurers are actually providing less coverage, shifting coverage from occurrence to claims made, or offering an attractive discount that may not be sustainable.  If a quote seems too good to be true, we suggest that you give MLMIC a call at (716) 648-5923. MLMIC is always willing and available to speak with you directly, and they can be very helpful in identifying the similarities and/or differences that impact the costs associated with medical liability insurance. 

NYACP continues to work with the Medical Liability Mutual Insurance Company (MLMIC) – a mutual professional liability insurance company owned by the healthcare providers it insures to bring you information on liability trends, resources and assistance. As the Chapter's endorsed Medical Liability Carrier, and with 40 years of experience, MLMIC is available to answer your questions.


Physician Quality Reporting System: 2016 Informal Review Process


In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment. 

If practice sites believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment, they may submit an informal review between September 9, 2015 and November 9, 2015 requesting CMS investigate incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review or appeal. 

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available through November 9, 2015 under the Related Links section of the Physician and Other Health Care Professionals Quality Reporting Portal

Please see How to Request an Informal Review of 2014 PQRS Incentive Eligibility and 2016 PQRS Negative Payment Adjustment (available soon on the Analysis and Payment section of the PQRS website) for more information. 

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.

PQRS/Value-Based Payment Modifier: "What Medicare Professionals Need to Know in 2015" Video Presentation Posted to YouTube

A video recording of the "PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015" presentation has been posted to the CMS MLN Connects® page on YouTube.  This presentation is the same as the webinars that were delivered on March 31, 2015 and April 7, 2015 by the Philadelphia Regional Office. 

Follow this link to view the video: https://youtu.be/Ww0oH-FhaYM      


Value Based Payment Reform Proposal Aims to Align Medicare and Medicaid in New York State


The Centers for Medicare & Medicaid Services (CMS) and New York State (NYS) are working together to improve outcomes for patients and populations, rewarding the delivery of high value care by providers and increasing long-term financial sustainability.  NYS has proposed an approach which was approved by CMS on July 22, 2015 to maximally align CMS’ payment reform efforts for Medicare with NYS’ Medicaid Payment Reform Roadmap.

The State’s five-year Roadmap proposes to allow providers and Managed Care Organizations to include Medicaid beneficiaries in CMS innovative payment models (such as ACO’s, Integrated Primary Care models, Bundled Payments for Care Improvement [BPCI]) and  NYS to include Medicare Fee-For-Service patients in its Value Based Payments (VBP) arrangements.

The suggested reforms propose advantages for patients, providers, the State and CMS, however public comment is solicited by the end of August since these proposals will result in significant change.

  • Patient barriers and discontinuities across systems (dual eligible) will be eliminated.
  • Providers should be able to focus on a consistent set of Alternative Payment Models (APM) for both Medicare and Medicaid.
  • There will be provider incentives for transitioning to VBP arrangements.
  • Providers with experience in APMs in one program should be able to seamlessly use their knowledge and infrastructure in the other program.
  • Reduction in administrative costs resulting from alignment between payment mechanisms.
  • Financially weak safety-net providers in NYS will be supported and rewarded for delivering value.
  • The State’s proposal requests CMS to align its reforms with NYS (and vice versa), thereby offering a significant step for CMS to achieve its goal of realizing 50% of Medicare payments tied to quality or value through APMs by the end of 2018.

The proposed alignment document can be viewed here. Please submit comments to NYACP Executive Director Linda Lambert no later than Wednesday, August 26.


5 Traits to Look for in a Medical Liability Claims Department


No physician wants to be named in a legal action. But if and when it happens, you’re going to have to rely heavily on the knowledge and expertise of claims staff to handle and obtain favorable outcomes. A short list of insurer attributes that can make a difference to your claims can be found Here.


Liability Risks with the Use of Electronic Health Records

In response to the increased use of electronic health records (EHR) and questions about  possible risks, MLMIC (the Chapter’s endorsed Medical Liability Company) has prepared a Special Edition of their Dateline publication - (Spring 2015 - Volume 14, Number 2).

This special issue also reviews patient health risks that can result from medical identity theft and discusses issues with requests for electronic copies of medical records.

If you have questions about these topics, please contact MLMIC directly.


Exploring New Payment Models: The NYACP, CMS, and Transforming Clinical Practice Initiative


NYACP continues to work on initiatives that target new payment models and assist members with practice transformation. The CMS Transforming Clinical Practice Initiative (TCPI) is designed to help clinicians achieve large-scale practice transformation. There are two initiatives within TCPI: Practice Transformation Networks (PTN) will be formed by group practices, health care systems and others to provide clinical practices with quality improvement expertise, technical assistance and help as they prepare for clinical and operational practice transformation. Support and Alignment Networks (SANs) will be formed by professional associations that align memberships, communication channels, CME credits and other work to support the PTNs and clinician practices. NYACP is actively involved with these initiatives.

New York State was awarded one of the CMS State Innovation Model (SIM) Initiative - Model Test Awards, designed to provide financial and technical support over a four-year period to test and evaluate multi-payer health system transformation models. Linda Lambert, NYACP Executive Director, was appointed to the SIM’s Integrated Care Workgroup.


Efforts to Improve Patient Safety Result in 1.3 Million Fewer Hospital Acquired Conditions with 50,000 Lives Saved
Hospital-acquired conditions decline by 17 percent over a three-year period


report released by HHS on December 2 shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act, such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative. Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013. This translates to a 17 percent decline in hospital-acquired conditions over the three-year period.


From Hospital to Home:
A Transitioning Care Partnership



The New York Chapter, through the work of our Hospitalist Task Force and workgroup, has just released a white paper outlining suggested roles and responsibilities between hospitalists and ambulatory care physicians when transitioning patients. The finished pamphlet can be viewed here, and is available for download as a PDF. Please take the time to read through this helpful resource and use it as appropriate in your own medical community.


 


ACO Updates

Proposed New York ACO regulations: What You Should Know About Becoming a Certified ACO

On October 15, the New York State Department of Health published proposed regulations setting forth standards for the issuance of certificates of authority to Accountable Care Organizations ("ACOs"). Although becoming a certified ACO is voluntary, there are many enticing benefits for those parties that choose to become certified.

You can read the full article here.


New Initiative to Support Care Coordination Nationwide

On October 15, CMS announced the availability of a new initiative for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program.

The new ACO Investment Model is designed to coordinate care to rural and underserved areas by providing up to $114 million in upfront investments to up to 75 ACOs across the country. Through the CMS Innovation Center, this initiative will provide up front investments in infrastructure and redesigned care processes  to help eligible ACOs continue to provide higher quality care. This will help increase the number of beneficiaries - regardless of geographic location - that can benefit from lower costs and improved health care through Medicare ACOs. CMS will recover these payments through an offset of an ACO's earned shared savings.

Eligibility is targeted to ACOs who joined the Shared Savings Program in 2012, 2013, 2014, and to new ACOs joining the Shared Savings Program in 2016. The application deadline for organizations that started in the Shared Savings Program in 2012 or 2013 will be December 1, 2014. Applications will be available in the Summer of 2015 for ACOs that started in the Shared Savings Program in 2014 or will start in 2016.

For more information, visit the ACO Investment Model web page.

Full text of this excerpted CMS press release (issued October 15).


Education Credits Now Available for Three CMS Quality Program Webinars

 

 

Please read the message below regarding education credits now available for the three web-based trainings that were posted on YouTube by MLNConnects iin June 2014.  To see a listing of all available courses, go to the Web-Based Training Course listing.

1.   "The CMS Physician Quality Reporting System (PQRS) Program: What Medicare Eligible Professionals Need to Know in 2014” Web-Based Training Course — Released

The The CMS Physician Quality Reporting System (PQRS) Program: What Medicare Eligible Professionals Need to Know in 2014” Web-Based Training (WBT) Course was released and is now available. This WBT is designed to provide an overview of the requirements of the Medicare PQRS program, so that all eligible professionals can participate to earn the incentives that are available in 2014 for successfully participating in the program, as well as to avoid the payment adjustment in 2016 for not reporting this year. This presentation educates healthcare professionals on a variety of topics that are essential to the CMS PQRS program. Continuing education credits are available to learners who successfully complete this course. See course description for more information.

To access the WBTs, go to MLN Products and click on “Web-Based Training Courses” under “Related Links” at the bottom of the web page.

2.   "The CMS Value-Based Payment Modifier: What Medicare Eligible Professionals Need to Know in 2014” Web-Based Training Course — Released

The “The CMS Value-Based Payment Modifier: What Medicare Eligible Professionals Need to Know in 2014 Web-Based Training (WBT) Course was released and is now available. This WBT is designed to provide an overview of the value-based payment modifier, and how it relates to the Physician Quality Reporting System (PQRS) program, so that all Medicare physicians will understand how the value modifier can effect Medicare reimbursement starting in 2015. This presentation educates healthcare professionals on a variety of topics that are essential to the value-based payment modifier.Continuing education credits are available to learners who successfully complete this course. See course description for more information.

To access the WBTs, go to MLN Products and click on “Web-Based Training Courses” under “Related Links” at the bottom of the web page.

3.  "The Medicare and Medicaid EHR Incentive Programs: What Medicare and Medicaid Providers Need to Know in 2014” Web-Based Training Course — Released

The “The Medicare and Medicaid EHR Incentive Programs: What Medicare and Medicaid Providers Need to Know in 2014” Web-Based Training (WBT) Course was released and is now available. This WBT is designed to provide an overview of the requirements of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, so that providers can participate to earn the incentives that are available in 2014 for successfully attesting the meaningful use objectives and clinical quality measures, as well as to avoid the payment adjustment in 2016 for not reporting this year. This presentation educates healthcare professionals on a variety of topics that are essential to the EHR Incentive Programs. Continuing education credits are available to learners who successfully complete this course. See course description for more information.

To access the WBTs, go to MLN Products and click on “Web-Based Training Courses” under “Related Links” at the bottom of the web page.


Infection Control - Hand Hygiene Recommendations Released

Several professional societies, including the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America, recently released recommendations on preventing health care-associated infections through hand hygiene.

The recommendations were sponsored by SHEA and aimed to provide practical advice based on updated scientific evidence and to help health care facilities implement programs to improve hand hygiene adherence. Recommendations on basic practices for hand hygiene at all acute care hospitals included the following:

  • Routine hand hygiene with alcohol-based hand rubs (AHRBs) should involve a product with at least 62% alcohol.
  • Antimicrobial or nonantimicrobial soap should be available/accessible in all patient care areas for routine hand hygiene.
  • Clinicians should be involved in choosing products for hand hygiene to improve adherence.
  • Unit- or institution-specific barriers to hand hygiene should be assessed with clinicians to identify locally relevant interventions.
  • Hand hygiene adherence should be measured by direct observation, product volume, or automated monitoring.
  • Preferential use of soap and water should be considered during norovirus outbreaks by clinicians caring for patients with known or suspected infection, in addition to contact precautions.
  • Hot water should not be used for hand washing because of skin irritation.
  • AHBRs should not be used when hands are visibly soiled.
  • Triclosan-containing soaps should not be used.

    The recommendations also included sections on recommended strategies for hand hygiene improvement, performance measures, and implementation strategies. The full text was published July 16 by Infection Control and Hospital Epidemiology and is available online.

Source: http://www.acpinternist.org/weekly/archives/2014/7/22/index.html#5


Resource Library

Additional Resources

Go to the Practice Management section for detailed information on tools and resources to help improve quality and transform your practice.

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Last Updated 7.22.16

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