Objectives

1. The National Quality Strategy & CMS Quality Strategy MedPac Recommendations and Impact on Nursing PracticeLouisiana Association for Healthcare QualityAnnual Education ConferenceApril 10, 2014Rebecca Hightower MS, RN, CPHQ, CPE Quality Improvement SpecialisteQHealth Solutions This material is presented by eQHealth Solutions, the Medicare Quality Improvement Organization for Louisiana, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. LA10SoW2B14-3042

2. The learner will be able to describe the National Quality Strategy and the CMS Quality Strategy and their impact on nursing practice. The learner will be able to describe CMS program changes for the hospital readmissions reduction program (HRRP) and their impact on nursing practice. The learner will be able to describe the MedPAC recommendations for refining the HRRP and the potential impact on nursing practice. The learner will be able to describe the MedPAC recommendations for approaches to CMS provider payment bundling and the potential impact on nursing practice. The learner will be able to describe the MedPAC recommendations for approaches to Medicare hospice policy issues and the potential impact on nursing practice. Objectives

3. Patient Protection & Affordable Care Act of 2010 (ACA) Required a National Quality Strategy to “improve the delivery of healthcare services, patient health outcomes, and population health Build a consensus on how to measure quality so that stakeholders can align their efforts for maximum results The National Quality Strategy

4. A national blueprint for achieving a high-value healthcare system Sets clear goals to support efforts to improve the quality of health and healthcare. The National Quality Strategy www.qualityforum.org/npp/

5. 3 Aims Better care Affordable care Health people & communities The National Quality Strategy www.qualityforum.org/npp/

6. Vision Safe, affordable, value-driven healthcare is attainable Current trends can be reversed with Americans becoming healthier & stronger Public & private sector leaders rowing together in the same direction toward the same finish line. The National Quality Strategy www.qualityforum.org/npp/

7. Strategic opportunities to accelerate improvement across all NQS aims & priorities The National Priorities Partnership www.qualityforum.org/npp/

8. Four National Goals for the NQS Eliminating harm Eradicating disparities Reducing disease burden Removing waste in healthcare The National Priorities Partnership www.qualityforum.org/npp/

9. Six Priorities for the NQS The National Priorities Partnership

10. The National Priorities & Goals Making care safer by reducing harm caused in the delivery of care.

11. The National Priorities & Goals

12. Engage patients and families as partners in their care. The National Priorities & Goals

13. The National Priorities & Goals

14. Believe in the Power of the Patient

15. The National Priorities & Goals Promote effective communication and coordination of care.

16. The National Priorities & Goals

17. The National Priorities & Goals Promote the most effective prevention and treatment practices for the leading causes of mortality

18. The National Priorities & Goals

19. Work with communities to promote wide use of best practices to enable healthy living. The National Priorities & Goals

20. The National Priorities & Goals

21. The National Priorities & Goals Make quality care more affordable for individuals, families, employers, and governments by developing and spreading new healthcare delivery models.

22. The National Priorities & Goals

23. Progress Nationwide initiatives launched to improve healthcare quality in each of the six priorities Partnership for Patients Million Hearts Campaign Multi-Payer Advance Primary Care Practice Demonstration Interagency Working Group on Health Care Quality Agency for Healthcare Research and Quality (AHRQ) The National Quality Strategy www.ahrq.gov/workingforquality/nqs/nqs2012annlrpt.pdf

24. Progress Alignment of measurement approaches Measures Application Partnership National Strategy for Data Collection, Measurement, & Reporting Reducing the burden of healthcare providers working to improve quality EHR Incentive Program Meaningful Use Organizational Infrastructure at the Community Level Promote comparability of measurement data The National Quality Strategy

25. Progress Established key measures to be used to track national progress in each of the six priorities States adopting the NQS & using it to Demand higher quality from private health insurers Improve the quality of care for Medicaid recipients The National Quality Strategy www.ahrq.gov/workingforquality/nqs/nqs2012annlrpt.pdf

26. Progress Payment & Delivery Systems Reforms HHS offers more than three dozen opportunities for providers across the care spectrum to participate in pilot programs to improve quality and reduce the cost of care. The National Quality Strategy

27. Next Steps HHS will continue to pare down and consolidate the measures that providers are required to collect and report. Enthusiastic engagement with private payers, through the Measures Application Partnership and the Buying Value initiative, will continue to drive this work. There is a growing body of evidence on how to keep patients safer, how to best coordinate care to improve outcomes, and how to lower costs through improvement. Future iterations of this report will highlight specific best practices and point stakeholders from across the health care sector—payers, clinicians, communities, and consumers—to resources that guide quality improvement work for all populations. The National Quality Strategy

28. The CMS Quality Strategy

29. To optimize health outcomes by improving clinical quality and transforming the health system. The CMS Quality Strategy - Vision

30. Lead quality measurement alignment, prioritization, and implementation and the development of new innovative measures Guide quality improvement across the nation and foster learning networks that generate results Reward value over volume of care Develop and implement innovative delivery system and payment models to improve care and lower costs Collaborate across CMS, HHS, and with external stakeholders The CMS Quality Strategy - Mission

31. Listen to the voices of beneficiaries and patients as well as those who provide healthcare Foster an environment that will create the capacity for providers to improve quality through use of locally generated data and local innovations in care delivery Be a model of effective business operations, customer support, and innovative information systems that excel in making meaningful information available Develop individuals, create high-functioning teams, foster pride and joy in work at all levels, continuously learn, and strive to improve The CMS Quality Strategy - Mission

32. Beneficiaries and Patients Come First – We put first the best interest of the people we serve. Public Service – We take pride in our unique and privileged role in the healthcare of the nation. Integrity – We hold ourselves to the highest standards of honesty and ethical behavior. Accountability – We earn trust by being responsible for the outcomes of our actions. Teamwork – We foster unconditional teamwork and regard every employee in CMS as available and willing to help others. The CMS Quality Strategy - Values

33. External Collaboration – We strive to work in full cooperation with the private sector. Innovation – We encourage finding and testing new ideas in all that CMS does. Excellence – We are committed to strengthening our organizational culture of striving for excellence in our products and services as well as in how we do business. Respect – We treat all our stakeholders and one another with the utmost respect and professionalism. The CMS Quality Strategy - Values

34. The CMS Quality Strategy – Foundational Principles • Eliminate Racial and Ethnic Disparities • Strengthen Infrastructure and Data Systems

35. The CMS Quality Strategy – Foundational Principles • Enable Local Innovations • Foster Learning Organizations

36. The CMS Quality Strategy – Drivers & Policy Levers • Measuring & publicly reporting providers’ quality performance • Providing technical assistance & fostering learning networks for quality improvement (QI) • Adopting evidence-based national coverage determinations

37. The CMS Quality Strategy – Drivers & Policy Levers • Setting clinical standards for providers that support QI • Creating survey and certification processes that evaluate capacity for quality assurance & QI

38. The CMS Quality Strategy – Goal #1 • Make care safer by reducing harm caused in the • delivery of care • Improve support for a culture of safety • Reduce inappropriate & unnecessary care • Prevent or minimize harm in all settings

39. The CMS Quality Strategy – Goal #2 • Strengthen person & family engagement as partners in their care • Ensure all care delivery incorporates patient & caregiver preferences • Improve experience of care for patients, caregivers, and families • Promote patient self-management

40. The CMS Quality Strategy – Goal #3 • Promote effective communication & coordination of care: • Reduce admissions and readmissions • Embed best practices to manage transitions to all practice settings • Enable effective healthcare system navigation

41. The CMS Quality Strategy – Goal #4 • Promote effective prevention & treatment of chronic disease • Increase appropriate use of screening & prevention services • Strengthen interventions to prevent heart attacks & strokes • Improve quality of care for patients with multiple chronic conditions (MCCs)

42. The CMS Quality Strategy – Goal #4 • Promote effective prevention & treatment of chronic disease • Improve behavioral health access & quality of care • Improve perinatal outcomes

43. The CMS Quality Strategy – Goal #5 • Work with communities to promote best practices of healthy living • Partner with & support federal, state, and local public health improvement efforts • Improve access within communities to best practices of healthy living

44. The CMS Quality Strategy – Goal #5 • Work with communities to promote best practices of healthy living • Promote evidence-based community interventions to prevent & treat chronic disease • Increase use of community-based social services support

45. The CMS Quality Strategy – Goal #6 • Make care affordable • Develop & implement payment systems that reward value over volume • Use cost analysis data to inform payment policies

46. About eQHealth Solutions • The Department of Health & Human Services’ (DHHS) National Quality Strategy is the framework for the healthcare initiatives implemented in recent years by the Centers for Medicare & Medicaid Services (CMS). • The CMS Medicare Quality Improvement Organizations (QIOs) are an independent network dedicated to promoting the goals of the National Quality Strategy in each state & territory.

47. About eQHealth Solutions • eQHealth has served as the CMS Medicare QIO in Louisiana for over 27 years. • As the QIO, our work is based on the goals & priorities of the national and CMS quality strategies. • We are a free resource for meeting the requirements of CMS Quality Reporting programs and improving quality & safety of patient care and care transitions.

48. A bold new charter from CMS Healthcare professionals are experienced, committed, and understand the challenges involved in widespread adoption of best practices for achieving significant improvements in the quality and safety of healthcare for their patients.

49. Finances • Payment reform for hospitals • CMS payment reform increasing the stakes • Potential negative impact to base DRG payments* *Alexander, K., LHA Legislative & Regulatory Update. LA Assn for Healthcare Quality Annual Education Conference. April 2012

50. Hospital Readmissions Reduction Program (HRRP) Medicare Payment Reform – MedPAC Recommendations