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Quality and Health Care Reform. Kate Navarro-McKay, Partnership for Quality Care. October 5, 2010. About Partnership for Quality Care. Members include nation’s largest healthcare union with more than 1 million caregivers. Member organizations provide care to 60 million patients annually

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Quality and health care reform
Quality and Health Care Reform

  • Kate Navarro-McKay, Partnership for Quality Care

October 5, 2010

About partnership for quality care
About Partnership for Quality Care

  • Members include nation’s largest healthcare union with more than 1 million caregivers.

  • Member organizations provide care to 60 million patients annually

  • Members include diverse health care providers, many states, national leaders in quality.

  • Goal: Reliable and affordable access to healthcare coverage for all Americans within a health care system that aggressively promotes improved quality and efficiency.

Remember health reform headlines
Remember Health Reform Headlines?

  • Search of US Newspapers & Wire Stories finds:

    • Hospital Readmissions: 497 News Stories

    • Death Panels:

1,750 News Stories

Major provisions of the ppaca
Major Provisions of the PPACA

  • Insurance Coverage Expansions

  • Patient Protection & Insurance Market Reform

  • Revenue Measures & Deficit Reduction

  • Spur System Delivery Changes

What s all this then
What’s All This, Then?

  • Requirement that chain eateries post calorie counts

  • Break time for nursing mothers to express breast milk

  • Why? Ask Joe Biden.

Major areas of quality impact

Familiar Quality Approaches: Reports, Measurements & Penalties

Hospital Readmissions & Hospital Acquired Conditions

Standardized LTC Complaint Form & Review of 5-Star Rating System

Value Based Purchasing

Public Reporting & Increased Data Collection

Higher Penalties & Many Disputes

National Strategy for Quality Improvement

New Models of Reimbursement & Care Delivery

Accountable Care Organizations

Bundled Payments

Medical Home Demonstrations

Community-based Care Transitions Demo

Center for Medicare and Medicaid Innovation

Comparative Effectiveness Research

Major Areas of Quality Impact

And don t forget healthcare it
...And Don’t Forget Healthcare IT Penalties

  • ARRA (“Stimulus Bill”) provides $20 billion in HIT funding

    • back-loaded to hit in 2011, mostly incentive payments for meaningful use of certified health IT

  • PPACA Innovations Demand Effective Information Sharing

    • HIT seen as key “connection” facilitator

Just the tip of the iceberg
Just the Tip of the Iceberg... Penalties

Demonstration on Culture Change and the Use of Information Technology in Nursing Homes

  • “Demonstration”

    • 312 Mentions

  • “Pilot”

    • 80 mentions

Independence at Home Medical Practice Pilot Program

Value-Based Purchasing Demonstration Programs

Demonstration Projects to Address Health Professions Workforce Needs

Demonstration Concerning Individualized Wellness Plans

Demonstration Project to Evaluate Integrated Care Around a Hospitalization

Pilot Testing Pay-for-Performance Programs for Certain Medicare Providers

Pqc response to health reform
PQC Response to Health Reform Penalties

  • Culture of Health Project—“Next Phase” of Health Reform

    • 4 areas of nationwide goals for clinical improvement (readmissions, sepsis, HAIs, asthma)

    • Health Improvement for Healthcare Workforce

    • Workforce Innovation and Investment

    • Nationwide, Expansive, Ambitious

What s a nurse got to do with it
What’s a Nurse Got To Do With It? Penalties

  • Nurses are Key to Making Quality Innovations Work for Patients and Organizations

    • High Level of Patient Interaction

    • Provide Continuity, Command Respect, Possess Expertise

    • Care Team Leader

What should we be doing
What Should We Be Doing? Penalties

  • Anticipating Change: Once in a Generation Opportunity

  • Asking Yourself How Can We Think “Outside the Box”

  • Working Collaboratively on Institutional Priorities

  • Partnering With Administrators and Leaders to find the “Win-Win-Win”for Patients, Providers, and the Institution

  • Think about Systems and Teams

Questions? Penalties

Kate navarro mckay partnership for quality care knm@pqc usa org 701 428 1298
Kate Navarro-McKay PenaltiesPartnership for Quality Careknm@pqc-usa.org701-428-1298