1 strategies today for higher quality tomorrow brady augustine senior executive for esrd program...
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Strategies Today for Higher Quality Tomorrow
Brady AugustineSenior Executive for ESRD Program
& Acting Director, DCCP
March 25, 2004
0% 100%
LEVEL OF PERFORMANCE
NU
MB
ER
OF
OB
SE
RV
AT
ION
S
1998-1999
2000-2001
2024-2025(Projection)
Pursuing Excellence
ESRD Stakeholders Meeting3
CMS Approach to Quality
Secretary Thompson announces HHS Healthcare Quality Initiative (Nov 2001): Stimulate / support providers & clinicians to improve the quality of health care Empower consumers to make more informed decisions regarding their healthcare
ESRD Stakeholders Meeting4
44WHAT WE CAN DO TO IMPROVE QUALITY
IDENTIFY IMPROVEMENT OPPORTUNITIES AND SELECT APPROPRIATE IMPROVEMENT INTERVENTIONS
ADOPT OR DEVELOP MEASURES
COLLECT & ANALYZE DATA
SELECT PRIORITY AREAS
MANAGE PROCESS IN PARTNERSHIP WITH STAKEHOLDERS
ESTABLISH&
ENFORCE STANDARDS
STRUCTURE COVERAGE
AND PAYMENTS TO IMPROVE
CARE
SUPPORT STANDARD METHODS
GIVE CONSUMERS
INFOR-MATION
AND ASSISTANCE
TO MAKE CHOICES
PROMOTE OR CREATE
COLLABORA-TIONS ANDPARTNER-
SHIPS
GIVE PLANS,
DOCTORS&
PROVIDERS TECHNICAL
ASSISTANCE
REWARD DESIRED
PERFORM-ANCE
ESRD Stakeholders Meeting5
CMS Quality Initiatives
Nursing Homes – launched November 2002 Home Health – launched November 2003 Hospitals – developmental – 2004/2005 ESRD – developmental - 2005
ESRD Stakeholders Meeting6
Comparative Quality Information
Medicare Personal Plan Finder - 1999 Dialysis Facility Compare - 2001 Nursing Home Compare - 2002 Home Health Compare – 2003 Hospital Compare – 2004/2005
ESRD Stakeholders Meeting7
A focus on consumer information, complemented by additional tactics
ESTABLISH&
ENFORCE STANDARDS
REWARD DESIRED
PERFORM-ANCE
SUPPORT STANDARD METHODS
GIVE CONSUMERS
INFOR-MATION
AND ASSISTANCE
TO MAKE CHOICES
PROMOTE OR CREATE
COLLABORA-TIONS ANDPARTNER-
SHIPS
GIVE PLANS,
DOCTORS&
PROVIDERS TECHNICALASSISTANCE
STRUCTURE COVERAGE
AND PAYMENTS
TO IMPROVE CARE
ESRD Stakeholders Meeting8
Support Standard Methods
Clinical Performance Measures Core Data Set ESRD CAHPS Survey ESRD Networks – performance based
contracting
ESRD Stakeholders Meeting9
Promote or Create Collaborations and Partnerships
ESRD Open Door Forum ESRD Stakeholder Meetings Technical Expert Panels Fistula First Project Advisory Board for new Expanded
Bundle Demonstration
ESRD Stakeholders Meeting10
Provide Technical Assistance
ESRD Networks State Survey Agencies
ESRD Stakeholders Meeting11
www.medicare.gov– Dialysis Facility Compare Website – Publications– Medicare coverage information– Medicare eligibility tool– Other Compare Tools
Give Consumers Information and Assistance to Make Choices
ESRD Stakeholders Meeting12
Reward Desired Performance
ESRD Disease Management Demonstration
ESRD Stakeholders Meeting13
Structure Coverage and Payment to Improve Care
HMA (Hematocrit Measurement Audit) Program Memorandum
National Coverage Determination Process Evaluation of Vascular Access Payment Policy Change in Monthly Capitation Payment for
nephrologists
ESRD Stakeholders Meeting14
Establish and Enforce Standards
ESRD Conditions for Coverage Survey and Certification
– Increased funding– Increased training– Improved consistency– Improved accuracy
ESRD Stakeholders Meeting15
Medicare Modernization Act (2003)
IOM report on performance measures (Sec. 238)– Evaluate leading health care performance measures– Identify and prioritize options to implement policies
that align performance with payment under the Medicare Program
ESRD Stakeholders Meeting16
Medicare Modernization Act (2003)
Payment for Renal Dialysis Services (Sec. 623)– Increases base composite rate by 1.6% (2005+)– OIG report on acquisition price for drugs (Apr 2004)– Basic case-mix adjusted payment system that
includes add-on of “spread” between acquisition and 95% AWP for separately billable drugs (2005+)
– Report to Congress on expanded bundle (Oct 2005)– Demonstration project for expanded bundle (2006-
2008)
ESRD Stakeholders Meeting17
Medicare Modernization Act (2003)
Medicare Care Mgmt Performance Demo (Sec. 649)– Demonstration program for physicians– Includes quality incentives– Emphasizes health information technology and
evidence-based outcomes measures– 3 years and 4 sites – Eligible beneficiaries have 1 or more chronic
medical conditions
ESRD Stakeholders Meeting18
Medicare Modernization Act (2003)
Chronic Care Improvement in FFS (Sec. 721)– Requires the Secretary to phase in chronic care
improvement programs in fee-for-service – Phase I: develop, test, and evaluate care
improvement programs using RCT Eligible beneficiaries have 1 or more chronic conditions
(such as CHF, diabetes, chronic obstructive pulmonary disease (COPD) or others as selected by the Secretary
10 sites consisting of 30,000 beneficiaries each
– Phase II: expand successful efforts nationwide
ESRD Stakeholders Meeting19
More Information on theQuality Initiatives and ESRD
For more information: www.cms.hhs.gov/quality www.medicare.gov
– Comparative databases for NH, HH, M+C, Dialysis Facilities
www.cms.hhs.gov/medicarereform/ www.cms.hhs.gov/researchers/demos