Quality Key Ingredient in Healthcare Reform
Whether it’s the $940 billion cost over 10 years, the additional 32 million Americans who will be covered by insurance, or any of the other provisions found in its 3,200 pages, there’s still much about the recently signed healthcare reform package to dissect and digest.
But one thing about the legislation seems clear to some quality and patient-safety advocates: It’s a step forward in improving quality of care, the delivery of care and patient safety.
"Right now, there’s still so much focus on the political issues and the up-front costs," said David Levett, M.D., the immediate past chair of ASQ’s Healthcare Division and currently the chief medical officer of Physicians’ Clinic of Iowa in Cedar Rapids. "The good things will come through with time and will take a few years to put in place. They may not be as apparent right now."
James Conway, M.D., a senior fellow at the Institute for Healthcare Improvement in Boston, said the law undoubtedly raises the bar for quality. "This is saying, front and center, ‘We are declaring the current state unacceptable; we are going to reward great performance,’" Conway said. "And that creates an interesting tension, a push-pull."1
The Patient Protection and Affordable Care Act proposes ways to control costs, improve hospital performance and streamline healthcare delivery. Whether true cost savings and efficiencies will be realized, of course, remains to be seen.
"It’s really hard to estimate savings on a lot of this," Levett said. "There’s a concern that the costs will go up. In the short term, the costs will go up. In the long run, having more preventive care and more people insured, those [factors] over time will lower costs."
The dollar signs and politics surrounding the massive bill might have overshadowed many of the provisions related to quality, strategy, planning, process improvement and patient safety, including:
- Patient-Centered Outcomes Research Institute: This independent body will conduct research to inform public and healthcare providers about the risks and benefits of marketed drugs, devices and medical products, and recommend the most effective options.2
- Trauma center program: This new program will bolster emergency department and trauma center capacity and will fund research on emergency medicine. The program also will establish a commission to plan and oversee activities during national emergencies.3
- Workforce advisory committee: This panel will examine current and projected healthcare workforce supply and determine what steps to take to respond to and avoid doctor and nurse shortages.
- Patient safety center: The Center for Quality Improvement and Patient Safety will research and share information about improving the quality and safety of healthcare. The center will initially focus on preventing infections and reducing readmissions.4
- Wellness programs: Grants will be awarded to small businesses that establish wellness programs. There will also be incentives for employers to offer as much as 50% off insurance premiums to employees who participate in wellness programs.5
- Innovation center: Within the Centers for Medicare and Medicaid Services, this center will test, evaluate and expand different payment structures and methods to reduce program expenditures in Medicare, Medicaid and the Children’s Health Insurance Program while maintaining or improving quality of care.6
- Collaborative Care Network Program: The community-based program will support efforts by consortiums of healthcare providers to coordinate and integrate healthcare services for low-income uninsured and underinsured people.7
- Metrics and measures: Quality measures for reporting and reimbursing for federal health programs will be developed.8
- Bundled payments: A pilot program will be established to develop a method of bundled payments for providers to promote efficiencies and reduce spending.9
- Incentives and penalties: Incentives for hospitals that meet and exceed performance standards will be set, as well as penalties for hospitals with high readmission rates for treatment of heart failure, pneumonia and other conditions, and high error rates leading to medical harm.10
The law did not provide comprehensive tort reform. This could have drastically reduced the cost of medical malpractice insurance, which significantly adds to healthcare costs.
"They have to get some federal tort reform in place," Levett said. "The cost of practicing defensive medicine, the tests that we do to cover ourselves—this is something that is real."
—Mark Edmund, associate editor
- Cathleen F. Crowley, "Health Reform Can Cut Errors," Albany Times-Union, www.timesunion.com/aspstories/story.asp?storyid=917446, April 1, 2010.
- Mary Vanac, "Personalized Medicine Will Transform Health Industry, PWC Says," MedCity News, www.medcitynews.com/2010/04/personalized-medicine-will-transform-health-industry-pwc-says, April 2010.
- Emily P. Walker, "What’s in the Healthcare Reform Law," MedPage Today, www.medpagetoday.com/washington-watch/reform/19362, April 1, 2010.
- Crowley, "Health Reform Can Cut Errors," Albany Times-Union, see reference 1.
- Scott Donnelly, "Small-Business Leaders React to Health Care Reform Law," Glen Falls (NY) Post Star, www.poststar.com/news/local/article_f4d6a09a-3d3a-11df-aba2-001cc4c002e0.html, March 31, 2010.
- Henry J. Kaiser Family Foundation, "Summary of New Health Reform Law," www.kff.org/healthreform/upload/8061.pdf, March 26, 2010.
- Crowley, "Health Reform Can Cut Errors," Albany Times-Union, see reference 1.
Quality Advocate Berwick May Soon Head CMS
A well-known healthcare quality and efficiency advocate may soon be leading the Centers for Medicare and Medicaid Services (CMS). President Obama nominated Don Berwick, M.D., last month to become the administrator of CMS, the largest purchaser of healthcare in the United States.
Berwick—a self-described extremist in his advocacy of patient-centered care—heads the Institute for Healthcare Improvement (IHI), an independent, not-for-profit organization he founded almost 20 years ago. IHI works to improve healthcare quality and make health systems more efficient and cost effective. Berwick is also a pediatrician and Harvard professor.
As CMS chief, Berwick would run Medicare and Medicaid, programs that serve about 100 million people, or one-third of all Americans. No one has held the position permanently since October 2006, when Mark B. McClellan, M.D., stepped down.
In addition to being a doctor, professor and head of IHI, Berwick has worked extensively on an advisory commission and a panel to reduce medical mistakes and focus on patient safety.
Berwick, who has been ASQ member in the past, has repeatedly challenged doctors and hospitals to provide better care at lower costs and has said the government and insurers can increase quality and efficiency of care by basing payments on the value of services rather than volume.
—Nicole Adrian, contributing editor
- Clark, Cheryl, "10 Issues New CMS Administrator Will Face," HealthLeaders Media, www.healthleadersmedia.com/content/LED-249045/10-issues-new-cms-administrator-will-face (case sensitive).
- Pear, Robert, "Obama Chooses Health Policy Scholar as the Director for Medicare and Medicaid," New York Times, www.nytimes.com/2010/03/28/health/policy/28health.html?src=me&ref=health.
- Rauber, Chris, "Report: Obama Said to Name Quality Guru Don Berwick to Head Medicare," San Francisco Business Times, http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2010/03/22/daily85.html.
ASQ QUARTERLY QUALITY REPORT
Quality Used to Combat H1N1
Among the many challenges U.S. public health departments face, one in particular stands out: fewer resources to ensure residents get vaccinations and other services in a timely manner.
To combat this problem, more agencies have found process improvement methods and quality tools to be just the right prescription to improve efficiency and, in turn, bolster public safety, according to a recent ASQ report.
"H1N1 Influenza and Quality Tools: What Have We Learned?"—ASQ’s latest Quarterly Quality Report—addresses these challenges and how public health departments across the country are using quality tools for process improvement.
Specifically, the report describes how several public health agencies—with help from quality professionals and organizations such as Public Health Foundation (PHF) and the National Network of Public Health Institutes—have integrated continuous improvement tools and techniques to:
- Improve vaccine distribution.
- Improve client satisfaction with vaccination services.
- Strengthen communications to ensure a smooth flow of information.
PDSAs to plan ahead
In Florida, Grace Duffy, an ASQ fellow and quality consultant, is working with PHF to teach public health department staff to use quality tools to improve the response to the H1N1 outbreak and other pandemics.
Duffy also worked with PHF staff to conduct a gap analysis to review what worked in spring 2009 to improve services for a fall 2009 outbreak. A plan-do-study-act problem-solving process helped the department improve the immunization process to ensure the vaccine was delivered on time to the people who needed it and was not sitting unused past its expiration date.
Read the entire report at www.asq.org/quality-report/reports/201003.html.
—Nicole Adrian, contributing editor
PUBLICATIONS CATALOG PUBLISHED ASQ Quality Press has released its 2010 catalog, which contains 52 pages describing the journals, books, standards and other products and services ASQ offers to quality professionals. Call 800-248-1946 or 414-272-8575 to request a copy, or download the catalog at www.asq.org/quality-press.
ASQ EMPLOYEE NAMED BALDRIGE EXAMINER ASQ employee Peter LaBonte has been appointed to the board of examiners for the Malcolm Baldrige National Quality Award. Baldrige examiners review award applications and participate in site visits of award applicants.
SR MEDAL RECIPIENT ANNOUNCED Joanne Vincenten has been named the first recipient of ASQ’s Spencer Hutchens Jr. Social Responsibility Medal. Vincenten, the director of the European Child Safety Alliance of EuroSafe in The Netherland, has a strong reputation as a leader and advocate in the field of public health and child injury prevention. She will receive the medal at ASQ’s World Conference on Quality and Improvement this month in St. Louis.
A TOP U.S. EXECUTIVE has been named to head a Toyota North American quality task force. Steve St. Angelo, executive vice president of Toyota’s U.S. manufacturing operations in Erlanger, KY, was named the company’s chief quality officer in North America. For more information, visit http://articles.latimes.com/2010/mar/26/business/la-fi-toyota-quality26-2010mar26.
MONDAY, MAY 17, is the deadline to submit an application for the first Subir Chowdhury Fellowship on Quality and Economics. The three-month fellowship will allow the recipient to participate in academics at the Asia Research Centre, London School of Economics & Political Science. Applicants must be scholars in the social sciences with research experience on Bangladesh and India. Chowdhury is an ASQ member, author and consultant. For more details, visit www.lse.ac.uk/collections/asiaresearchcentre/who'swho/subirchowdhuryfellowship.htm.
A TWO-DAY QUALITY CONFERENCE will be held May 25-26 in Kuwait. More information about the Kuwait Quality Summit is available at www.kuwaitquality.com.
THE PROPOSED SOCIAL RESPONSIBILITY (SR) standard has progressed to the final draft phase. In February, the International Organization for Standardization (ISO) voted to move ISO 26000: Guidance on social responsibility from draft international standard status to final draft international standard status. ISO 26000 could be published as an international standard by year’s end. For more information, visit www.iso.org/iso/pressrelease.htm?refid=Ref1299 (case sensitive).
QP ONLINE ON PAPER
Quick Poll Results
Each month at www.qualityprogress.com, visitors can take an informal survey, and we post the results.
Here are the numbers from a recent Quick Poll:
What’s the best way to avoid a product recall?
- Identify potential sources of risk 59.6%
- Listen to customer feedback 16.3%
- Good internal communication 12.5%
- Strong social responsibility focus 11.5%
Visit www.qualityprogress.com for the most recent poll question:
"What aspect of healthcare reform will most affect quality of care?"
- Comparative effectiveness research
- Grants rewarding best practices
- Medicare reimbursing for quality of care
- Quality-based reporting requirements
Who’s Who in Q
NAME: Hamdy Youssef.
RESIDENCE: Pasadena, CA.
EDUCATION: Doctorate in philosophy and human and organization systems with a concentration in information society and knowledge organizations, Fielding Graduate University, Santa Barbara, CA.
CURRENT JOB: Corporate quality manager, Delafield Corp., which designs and manufactures hydraulic components and systems for the oil, gas and aerospace industries. Youssef also consults locally and internationally.
PREVIOUS EXPERIENCE: More than 20 years of broad-based quality management and business experience in different industries, including glass containers, semiconductors, electronics, medical devices, aerospace, optical coating and assembly, and electromechanical fabrication.
INTRODUCTION TO QUALITY: First heard about the new quality movement and W. Edwards Deming in 1980. At the time, he was an officer in the Egyptian Air Force and was visiting the United States for training through the U.S. Air Force.
ASQ ACTIVITIES: Senior member of ASQ.
OTHER ACTIVITIES: Was a member of the board of examiners for the Malcolm Baldrige National Quality Award (2001-2006) and a member of the board of examiners for the California Quality Award Programs (CAPE, 1996-2006). He also is a member of the Western Academy of Management and the Society of Automotive Engineers International, and he is an accredited RABQSA aerospace auditor. Youssef has worked with the Industrial Modernization Center in Egypt to implement a national excellence award scheme for quality, exports and innovation, training more than 150 examiners and senior examiners in 2005 and 2006.
PUBLISHED: Has written research papers on institutionalism, knowledge creation and power relations in organizations, systems theory and organization theories.
RECENT HONORS: Has received a number of certificates of appreciation from the U.S. Secretary of Commerce and the California Governor for serving on the boards of examiners of the Baldrige and CAPE awards.
FAVORITE WAYS TO RELAX: Long walks and hiking.
QUALITY QUOTE: Many people know how to set excellence goals. Few have a process in place for achieving them.