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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

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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

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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

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CMS Quality Initiatives

Nursing Homes – launched November 2002 Home Health – launched November 2003 Hospitals – developmental – 2004/2005 ESRD – developmental - 2005

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Comparative Quality Information

Medicare Personal Plan Finder - 1999 Dialysis Facility Compare - 2001 Nursing Home Compare - 2002 Home Health Compare – 2003 Hospital Compare – 2004/2005

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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

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Support Standard Methods

Clinical Performance Measures Core Data Set ESRD CAHPS Survey ESRD Networks – performance based

contracting

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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

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Provide Technical Assistance

ESRD Networks State Survey Agencies

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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

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Reward Desired Performance

ESRD Disease Management Demonstration

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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

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Establish and Enforce Standards

ESRD Conditions for Coverage Survey and Certification

– Increased funding– Increased training– Improved consistency– Improved accuracy

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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

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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)

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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

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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

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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