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October 30, 2013 / Issue 49

In this issue:

Taking ownership of patient engagement

Joint Commission annual report recognizes 1,099 Top Performer hospitals

Majority of ambulatory physicians had capability to exchange prescription and laboratory data in 2011

Number and characteristics of providers awarded Medicare Incentive Payments


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AHIMA

Taking ownership of patient engagement

ATLANTA – Patient engagement has no placebo effect. When patients have more access to their health information, they take greater ownership of their healthcare and can make better decisions to improve their outcomes.

Kim Murphy-Abdouch, MPH, RHIA, FACHE, a clinical assistant professor in the health information management department at Texas State University, challenged HIM professionals to facilitate this patient engagement. During her presentation, “Patient Access to Personal Health Information:

Regulation vs. Reality” on Monday at the American Health Information Management Association's (AHIMA) 85th annual Convention and Exhibit in Atlanta, she referenced an idea attributed to healthcare consultant Leonard Kish that, “if patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it.” Patient engagement is a key theme at AHIMA’s convention. AHIMA encourages all consumers to learn more about creating their own personal health record.

“HIM professionals can help break down the silos and barriers that prevent patients from accessing their personal health information,” said AHIMA CEO Lynne Thomas Gordon, RHIA, MBA, CAE, FACHE, FAHIMA. “HIM professionals and tools such as myPHR.com, AHIMA’s website on personal health records, can motivate and empower patients to better understand, access and control one of their most important assets – their personal health information.”

During Murphy-Abdouch’s presentation, she said that when a patient requests copies of notes and lab results from recent visits, HIM professionals can help tailor the information so that it will have the most value for the patient. She added that all employees at a healthcare organization should have familiarity with basic privacy and security requirements.

Murphy-Abdouch also announced preliminary findings from her research, which was a partnership between Texas State and the AHIMA Foundation. The research began with a survey of HIM directors and privacy officers. Almost 53 percent of the responses indicated that – as is their right – healthcare organizations charged for electronic copies of a patient’s health record; almost 65 percent charged for paper copies. The pricing varied between flat fees and per page fees.

Murphy-Abdouch called on healthcare organizations to not use a “one-size-fits-all” approach to handling personal health information (PHI) requests. For instance, patient requests should be looked at differently than third-party requests from long-term care insurance companies, life insurance companies and attorneys.

“With regard to charging for these requests, patients should be viewed with a different lens,” Murphy-Abdouch said.

Other findings of the survey of the 313 HIM directors and privacy officers from all but three states and the District of Columbia include:

  • 72.8 percent of healthcare organizations contract with a vendor to assist with the release of information function.
  • 73.5 percent of healthcare organizations use software to assist with the release of information function.

The idea for the survey originated out of a research training boot camp at Texas State University. The boot camp – a partnership between the AHIMA Foundation and the Texas State Institute for Health Information Technology – gives HIM educators and practitioners the background and skills necessary to seek funding for applied HIM research projects.

For more on AHIMA, visit www.ahima.org.

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HOSPITALS

Joint Commission annual report recognizes 1,099 Top Performer hospitals

OAKBROOK TERRACE, Ill. – October 30, 2013 – Thirty-three percent of Joint Commission-accredited hospitals reporting accountability measure data for 2012 are Top Performer hospitals, using evidence-based care processes that are delivered in the right way and at the right time, according to Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2013.

The 1,099 “Top Performer on Key Quality Measures” hospitals named in the new report represent a 77 percent increase in Top Performer organizations from last year. Of the 1,099 Top Performer hospitals, 424 achieved the distinction for two years in a row and 182 have earned the recognition every year since the program’s inception in 2011. Another 20 percent of Joint Commission-accredited hospitals reporting accountability measure performance data for 2012 were only one measure short of the Top Performer goal.

The Top Performer designation is based on performance related to accountability measures for heart attack, heart failure, pneumonia, surgical care, children’s asthma care, inpatient psychiatric services, venous thromboembolism (VTE) care, stroke care, and immunization. Hospitals are required to select and report on four measure sets, and each of the recognized hospitals had to achieve cumulative performance of 95 percent or above for all reported accountability measures. They also had to achieve performance of 95 percent or above on each and every reported accountability measure where there were at least 30 denominator cases. In addition, at least one core measure set had a composite rate of 95 percent or above, and within that measure set all applicable individual accountability measures had a performance rate of 95 percent or above. The list of Top Performer hospitals and the measure sets for which the hospital was recognized is available online at www.jointcommission.org/topperformer/.

The annual report also summarizes the performance of more than 3,300 Joint Commission-accredited hospitals on 47 accountability measures of evidence-based care processes closely linked to positive patient outcomes.

“By tracking the data found in each year’s edition of this report, you can see how results considered outstanding several years ago are now achieved by almost every Joint Commission-accredited hospital in America today. More than half of Joint Commission-accredited hospitals have reached or have nearly reached Top Performer distinction, showing that we are approaching a time in which consistent excellence in hospital performance on these important quality measures is the new normal,” says Mark R. Chassin, M.D., FACP, M.P.P., MPH, president and CEO, The Joint Commission. “This means patients are getting better care thanks to the shared commitment by hospitals to using data and proven quality improvement methods to always do the right thing and improve quality and safety.”

Hospital performance on accountability measures has improved significantly over time, greatly enhancing the quality of care provided in Joint Commission-accredited hospitals. The Joint Commission illustrates improvement with a “composite” result, which sums up the results of all individual accountability measures into a single summary score. In 2012, Joint Commission-accredited hospitals achieved 97.6 percent composite accountability measure performance on 18.3 million opportunities to perform care processes closely linked to positive patient outcomes – an improvement of 15.8 percentage points since 2002, when hospitals achieved 81.8 percent composite performance on 957,000 opportunities.

  • All measures tracked over at least two years showed improvement from the year of inception to 2012.
  • The 2012 heart attack care result is 98.8 percent, up from 88.6 percent in 2002 – an improvement of 10.2 percentage points. A 98.8 percent score means that hospitals provided an evidence-based heart attack treatment 988 times for every 1,000 opportunities to do so. This composite includes aspirin at arrival, aspirin at discharge, ACEI or ARB at discharge, beta-blocker at discharge, fibrinolytic therapy within 30 minutes, PCI therapy within 90 minutes and statin prescribed at discharge.
  • The 2012 pneumonia care result is 97.4 percent, up from 72.4 percent in 2002 – an improvement of 25.0 percentage points. This composite includes blood cultures in the intensive care unit (ICU), blood cultures in the emergency department (ED) and antibiotics to non-ICU patients.
  • The 2012 surgical care result is 98.3 percent, up from 82.1 percent in 2005 – an improvement of 16.2 percentage points. This composite includes antibiotics within one hour before the first surgical cut, appropriate prophylactic antibiotics, stopping antibiotics within 24 hours, beta-blocker patients who received beta-blocker perioperatively, cardiac patients with controlled postoperative blood glucose, patients with appropriate hair removal, prescribing VTE medicine/treatment, receiving VTE medicine/treatment and urinary catheter removed.
  • The 2012 children’s asthma care result is 95.5 percent, up from 79.8 percent in 2008 – an improvement of 15.7 percentage points. This composite includes relievers for inpatient asthma, systemic corticosteroids for inpatient asthma and home management plan of care.
  • The 2012 inpatient psychiatric services result is 89.7 percent, up from 80.5 percent in 2009 – an improvement of 9.2 percentage points. The composite includes continuing care plan created and continuing care plan transmitted.
  • The 2012 venous thromboembolism (VTE) care result is 91.0 percent, up from 82.7 in 2010 – an improvement of 8.3 percentage points. This composite includes VTE medicine/treatment, VTE medicine/treatment in ICU, VTE patients with overlap therapy, VTE patients with UFH monitoring and VTE warfarin discharge instructions.
  • The 2012 stroke care result is 96.2 percent, up from 92.7 percent in 2010 – an improvement of 3.5 percentage points. The composite includes anticoagulation therapy for atrial fibrillation/flutter, antithrombotic therapy by end of hospital day two, assessed for rehabilitation, discharged on antithrombotic therapy, discharged on statin medication, stroke education, thrombolytic therapy and VTE medicine/treatment.
  • The 2012 immunization result is 88.6 percent. This is the first year this measure set has been reported. The composite includes influenza vaccination and pneumococcal vaccination.
  • The percentage of Joint Commission-accredited hospitals achieving composite accountability measure performance greater than 95 percent* in 2012 is 83.0 percent, up from 74.6 percent in 2011 – an improvement of 8.4 percentage points. (*This threshold was 90 percent in previous annual reports, but was increased to 95 percent to better reflect the overall higher performance of the majority of Joint Commission-accredited hospitals).This composite includes all 2012 accountability measures except for one pneumonia care measure (antibiotics to ICU patients), the perinatal care measure set (includes elective delivery, antenatal steroids and exclusive breast milk feeding), and four inpatient psychiatric services measures. On two of the inpatient psychiatric services measures – hours of seclusion and hours of physical restraint – a lower score is preferred. The measures for multiple antipsychotic medications and justification for multiple antipsychotic medications were not included for 2012 only, since they were also not included in the calculations for the Top Performer on Key Quality Measures program for 2013. In 2008, only 33.8 percent of Joint Commission-accredited hospitals achieved 95 percent performance on measures in four sets – heart attack care, pneumonia care, surgical care and children’s asthma care.

Although hospitals achieved 95 percent or better performance on most individual measures, more improvement is needed. For example, hospitals can improve their performance on these measures relating to providing care plans or discharge instructions: creating home management care plans for child asthma patients (86.7 percent performance), transmitting continuing care plans for psychiatric patients (86.1 percent performance) and providing warfarin discharge instructions for VTE patients (82.2 percent performance). Some hospitals also perform better than others in treating particular conditions. In order to further improve performance, the required number of selected core measure sets for which a hospital must submit data to The Joint Commission will increase from four to six, effective January 1, 2014. By raising the bar, The Joint Commission is helping its accredited hospitals monitor and improve performance in more clinical conditions and patient populations.

For quality, safety and patient satisfaction results for specific hospitals, visit www.qualitycheck.org.

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Electronic data interchange

Majority of ambulatory physicians had capability to exchange prescription and laboratory data in 2011

A new study conducted by the Office of the National Coordinator for Health Information Technology (ONC) researchers, using data from a 2011 survey of physicians, finds that a majority of office-based physicians were able to view lab results and send medication data electronically. The study also finds that one-third of ambulatory care physicians could send and/or receive patient clinical summaries with other providers.

The results of this study are encouraging because they show that a majority of physicians who use electronic health records (EHRs) can electronically exchange test results, medication data and clinical care summaries with patients, all of which are integral to better care coordination and ultimately necessary for universal interoperability,” said Vaishali Patel, an ONC senior advisor and lead author of the study. “As Stage 2 of Meaningful Use moves forward, it will be important to continue monitoring physicians’ exchange capabilities and actual exchange activity to ensure that health information follows the patient wherever they go."

The ONC study found that the adoption of an EHR was the single strongest predictor of electronic exchange capability for e-prescribing, lab test viewing or ordering, and exchanging clinical summaries. However, results from the study show that not all EHR vendors offer equivalent exchange capability.

The top findings of the study, published today in the American Journal of Managed Care Vol. 19, No. 10, include:

  • 55 percent of all physicians had computerized capability to send prescriptions electronically vs. 78 percent of physicians with an EHR.
  • 67 percent of all physicians could view electronic lab results vs. 87 percent of physicians with an EHR.
  • 42 percent could incorporate lab results into their EHR vs. 73 percent of physicians with an EHR.
  • 35 percent could send an electronic order to a lab vs. 54 percent of physicians with an EHR.
  • 38 percent could provide clinical summaries to patients vs. 61 percent of physicians with an EHR.
  • 31 percent exchanged patient clinical summaries with another provider vs. 49 percent of physicians with an EHR.

Results of the study indicate that there was variation among physician exchange capability at the state level. Physicians in Massachusetts, Minnesota, North Dakota, Oregon, Vermont, Washington and Wisconsin reported the capability to exchange clinical information at rates significantly higher than the national average in at least four out of six measures of exchange capability examined.

Using data from 2011, the study authors posit that this is a baseline study of physician capability to exchange key types of clinical information. The study authors suggest that the Medicare and Medicaid EHR Incentives Programs and the State Health Information Exchange Program may drive improvement in physician exchange capability. Further, the study also suggests that health-care delivery reforms contained in the Patient Protection and Affordable Care Act, including Accountable Care Organization/shared savings programs, are likely to provide financial incentives to spur even greater health information exchange.

“Specifically, accountable care organizations, which allow entities to share cost savings, may create a business case for HIE by giving providers greater financial incentives to exchange information regarding their patients with each other. Additionally, financial penalties for high hospital readmission rates, for example, may spur greater care coordination between hospitals and ambulatory care providers to better manage transitions of care through the use of care summaries,” ONC researchers wrote.

Read the American Journal of Managed Care article.

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EHRs

Number and characteristics of providers awarded Medicare Incentive Payments

Hospitals and health care professionals, such as physicians, were awarded a total of approximately $6.3 billion in Medicare electronic health records (EHR) incentive payments for 2012, which is more than twice the $2.3 billion awarded to hospitals and professionals for 2011. Almost half of eligible hospitals and less than a third of eligible professionals received Medicare EHR incentive payments for 2012.

For 2012, the 2,291 hospitals that were awarded payments represent 48 percent of the eligible hospitals and an increase compared to 2011, when 777 hospitals, or 16 percent of those eligible, were awarded payments. Nationwide, 72 percent of hospitals were new to the program; that is, they were awarded an incentive payment for the first time. Participation varied among hospitals with certain characteristics. For example, acute care hospitals were nearly twice as likely as critical access hospitals to have been awarded an incentive payment for 2012. In addition, hospitals in rural areas were 3.1 times more likely to have been awarded an incentive payment for 2012 compared to 2011, a slightly greater increase than for hospitals overall.

Additionally, 183,712 professionals were awarded payments for 2012, which represents 31 percent of the eligible professionals and an increase compared to 2011, when 58,331 professionals, or 10 percent of those eligible, were awarded incentive payments. Nationwide, 75 percent of professionals that were awarded an incentive payment for 2012 were new to the program. General practice physicians were 1.5 times more likely than specialty practice physicians to have been awarded an incentive payment for 2012. In addition, professionals with the lowest total amount of Medicare Part B charges were 3.3 times more likely to have been awarded an incentive payment for 2012 compared to 2011, which was a slightly greater increase than for professionals overall.

Why GAO did this study

Widespread use of health information technology, such as EHR, has the potential to improve the quality of care patients receive and reduce healthcare costs. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 (Recovery Act), among other things, provided funding for various activities intended to promote the adoption and meaningful use of certified EHR technology, including the Medicare and Medicaid EHR programs. Starting in 2011, these programs have provided incentive payments for hospitals and professionals that demonstrate meaningful use of certified EHR technology and meet other program requirements established by the Centers for Medicare & Medicaid Services (CMS). This report provides information on certain providers, including hospitals and professionals, that were awarded Medicare EHR incentive payments for 2011 and 2012. Using data from CMS and other government and private sources, GAO determined the number and percentage of eligible providers awarded Medicare incentive payments; determined the amount of Medicare EHR incentive payments awarded to providers; and examined the characteristics of providers that were awarded Medicare EHR incentive payments.

Read the GAO report.

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