National Quality Strategy and Partnership for Patients to improve care

One year after passage of the Affordable Care Act, the Department of Health and Human Services (HHS) has unveiled two programs that will most certainly be transformative for U.S. healthcare, affecting both quality and safety.

With the announcement of the first-ever National Quality Strategy in March, HHS signaled a strong commitment to improving the quality of healthcare.

In essence, the strategy calls for substantial changes in the current system in order to promote three key goals:

  • Better care. Improving the overall quality of healthcare by making it more patient-centered, reliable, accessible, and safe.
  • Healthy Communities. Improving population health by means of proven interventions that look beyond higher quality medical care to address behavioral, social, environmental, and other important aspects of health.
  • Affordable Care. Reducing the cost of quality healthcare for individuals, families, employers, and governments.

To accomplish all of this, the Strategy calls for the creation of specific quantitative goals and measures across a wide range of priority areas including: making care safer, ensuring patient and family engagement in care, promoting effective communication and care coordination, supporting effective prevention and treatment of chronic conditions, working with communities on population health initiatives, and making quality care more affordable.

Interestingly, the goals, benchmarks, and standardized quality metrics are to be developed collaboratively by participating agencies in consultation with the private sector.

HHS envisions clinicians, employers, government, and healthcare advocates pushing one another to achieve higher levels of quality.

The second program, a Partnership for Patients, was launched on April 12. The “partnership” — one between the administration, the private sector, hospitals, and physicians — calls for a pledge of support for the goals set forth in the National Quality Strategy.

The focus here is putting a stop to millions of preventable injuries and complications — and potentially saving a whopping $55 billion in healthcare costs (up to $10 billion in Medicare alone) in just the next three years.

The program targets all forms of harm to patients, but the Partnership plans to start by asking hospitals to home in on nine specific types of medical errors and complications where the potential for dramatic reductions in harm rates has been demonstrated in real world settings across the country.

More than 500 hospitals, physician and nurse groups, consumer groups, and employers have already pledged their commitment to the new initiative.

The Partnership comes complete with a new round of financial support. For example, funds are available for reforms that help achieve two goals by the end of 2013:

  1. Decreasing hospital-acquired conditions by 40% compared with 2010 rates, thereby saving more than 60,000 lives over three years
  2. Reducing preventable complications associated with transitions of care from one setting to another, thereby decreasing hospital readmissions by 20% compared with 2010

Part and parcel of any new initiative, however, are new rules.

In addition to those designed to help doctors, hospitals, and other providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs), HHS has announced new payment rules.

By 2015, a portion of Medicare payments to most hospitals will be linked to whether the individual hospital is delivering safer care, using information technology effectively, and meeting patient needs.

Financial incentives for quality improvement and lower costs will be available to state Medicaid programs as well.

What are the implications for physicians?

For those of us in the medical profession, these programs deliver a “1-2 punch” to the gut.

As they take effect, transparency and accountability will become very real for each of us. The days when a physician can do as he or she pleases in an autonomous, unrestricted way are officially over.

Physicians who can expect to deflect the 1-2 punch are those with good core strengths. They will:

  • Have systems in place to measure and evaluate clinical practice
  • Practice evidence-based medicine
  • Attend to the full continuum of care

Physicians who are less likely to survive the blow are those who lack core strengths. They will be those who are:

  • Not cognizant of their responsibility for population health
  • Have no electronic medical record
  • Do not track patients with chronic conditions (e.g., diabetes, chronic heart failure)

The bottom line for all physicians is this: If you are still practicing medicine on a patient-by-patient basis with no feedback loop, you are in serious trouble. It’s time to get with the program!

To be honest, I’m not sure that I would have understood the significance of these groundbreaking announcements if I were only wearing my “internist” hat.

With my “health policy expert” hat firmly in place, though, I am thrilled to finally see the wisdom of the Institute of Medicine Reports (“To Err is Human” and “Crossing the Quality Chasm”) being transformed into national policy.

David B. Nash is Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University and blogs at Nash on Health Policy.

Originally published in MedPage Today. Visit MedPageToday.comfor more health policy news.

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  • John Ryan

    Dr. Nash, when wearing your “internist hat”, have you experienced the impact on your practice of past government initiatives? I spend at least an hour per day complying with mind-numbing paperwork & telephone calls necessary to obtain my patient’s basic prescriptions, diabetic supplies and access to appropriate diagnostic testing and treatment, all mandated by the mindless bureaucracy accompanying our government’s management of healthcare. You should realize that having the resources of a major university or large group practice supporting your patient care isn’t the norm for 80% of the physicians in this country. Or do you realize this, and support the co-opting of physician autonomy by large healthcare entities as a necessary evil?

    I’m sure that looking down from the mountaintop that you “health policy experts” occupy, the National Quality Strategy looks like the greatest thing since chocolate milk. It is time for you experts to admit the results of prior AHRQ quality programs have yet to prove a significant impact in patient safety or access since the Institute of Medicine Reports in 1999 (AHRQ 2010 Report: “Health care quality and access are suboptimal, especially for minority and low-income groups”). The median rate of improvement is a whopping 2.6% for outcomes, after expending billions of dollars in the past 12 years.

    Not surprisingly, over 80% of the AHRQ budget is given as grants to universities, private & public healthcare quality organizations. So that “health policy expert” hat should feel even more comfortable, flush with new cash from the ACA. Don’t worry about me and my patients, we’ll just make time to comply with more of those “transparency and accountability” requirements.

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