Patient Safety Science & Technology Summit 2014

1. Patient Safety Science & Technology Summit2014

2. Patrick Conway, MD, MSc • Chief Medical Officer, Centers for Medicare and Medicaid Services

3. Patient Safety Efforts at CMS

4. Discussion • Quality Levers • Quality Improvement Organization funding • Clinical Standards and Survey and Certification • Value-based Purchasing • CMS Innovation Center • New Models of Care Delivery • Partnership for Patients • Future Vision

5. Our Aims Better Health for the Population Lower Cost Through Improvement Better Care for Individuals

6. The Six Goals of the CMS Quality Strategy 1 2 3 4 5 6

7. Quality Improvement Organization Work to Reduce Harm • There are 53 Quality Improvement Organizations (QIOs) across 50 states and territories • Hundreds of millions of dollars in QI investment • Focused on multiple areas of harm and demonstrating results such as: • 53% Relative Improvement Rate in the reduction of Central-line associated bloodstream infections • Over 85,000 fewer days with urinary catheters for beneficiaries • Hospitals with higher than expected rates targeted

8. Nursing Home Highlight: Quality Care Collaborative • Ensure that every nursing home resident receives the highest quality of care. • Strives to instill quality and performance improvement practices, eliminate healthcare acquired conditions, and dramatically improve resident satisfaction • Over 5000 nursing homes engaged and generating results • Decreased anti-psychotic use in dementia residents • Decreased pressure ulcers and falls • Reduction in healthcare acquired infections and conditions

9. Reduced Potential for Adverse Drug Events 2,629 more beneficiaries have INRs within Therapeutic Range

10. 2,966 Pressure Ulcers Prevented or Healed

11. QIO Program Culture Change: Next Generation of Work • Next statement of work was released in Dec 2013 • Support Beneficiaries and their families and engage patients in all improvement activities • Learning collaboratives to drive transformation • Innovative ideas flow from the field • Measure and review often, while responding quickly to data • High reliability methods and utilize implementation science • Leverage partnerships and collaborations to drive improvement • Clear aims and continuous testing and learning to improve results

12. Clinical Standards and Survey and Certification • Responsible for quality and safety standards for providers (Conditions of Participation) and their enforcement • Significantly updated Hospital Conditions of Participation with more to come in the future • Working to update Home Health and Long-term care clinical standards • Survey and Certification guidance and enforcement (e.g. working to finalize guidance on inpatient monitoring) • Work with accreditors such as Joint Commission on shared goals of improved quality and safer systems

13. Transparency and Value-based Purchasing • Hospital Compare and other websites with performance measures and downloadable raw data (e.g. HAIs, patient safety composite) • Hospital Value-based purchasing with over $1 billion allocated to hospitals based on performance on quality and efficiency measures (including patient safety) • Finalized measures for the Healthcare Acquired Condition program which will negatively adjust payment by 1% to the bottom quartile of performers on key HAI measures and patient safety composite

14. National Results • Over 44% reduction nationally in central line associated bloodstream infections • Over 22% reduction nationally in surgical site infections • Positive results in multiple other areas of harm

15. Discussion • Quality Levers • Quality Improvement Organization funding • Clinical Standards and Survey and Certification • Value-based Purchasing • CMS Innovation Center • New Models of Care Delivery • Partnership for Patients • Future Vision

16. Delivery system and payment transformation Current State – Producer-Centered Volume Driven Unsustainable Fragmented Care Systems FFS Payment Systems Future State – People-Centered Outcomes Driven Sustainable Coordinated Care Systems New Systems and Approaches • Value-based purchasing • ACOs Shared Savings • Episode-based payments • Medical Homes • State Innovation • Data Transparency, etc

17. CMS Innovations Portfolio: Testing New Models to Improve Quality Initiatives Focused on the Medicaid Population • Medicaid Emergency Psychiatric Demonstration • Medicaid Incentives for Prevention of Chronic Diseases • Strong Start Initiative • Medicare-Medicaid Enrollees • Financial Alignment Initiative • Initiative to Reduce Avoidable Hospitalizations of Nursing Facility Residents Accountable Care Organizations (ACOs) • Medicare Shared Savings Program (Center for Medicare) • Pioneer ACO Model • Advance Payment ACO Model • Comprehensive ERSD Care Initiative Primary Care Transformation • Comprehensive Primary Care Initiative (CPC) • Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration • Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration • Independence at Home Demonstration • Graduate Nurse Education Demonstration Bundled Payment for Care Improvement • Model 1: Retrospective Acute Care • Model 2: Retrospective Acute Care Episode & Post Acute • Model 3: Retrospective Post Acute Care • Model 4: Prospective Acute Care Capacity to Spread Innovation • Partnership for Patients • Community-Based Care Transitions • Million Hearts Health Care Innovation Awards State Innovation Models Initiative

18. Innovation is happening broadly across the country

19. Partnership for Patients • 40% Reduction in Preventable Hospital Acquired Conditions • 1.8 Million Fewer Injuries • 60,000 Lives Saved • 20% Reduction in Preventable 30-Day Readmissions • 1.6 Million Patients Recover Without Readmission • CMS investing almost $1 billion • Potential to save billions • Broad national engagement – almost 80% of hospitals as well as consumers, employers, payers, and others

20. Ten Areas of Focus Hospital Engagement Networks are required to address ten areas of focus: • Adverse Drug Events • Catheter-Associated Urinary Tract Infections • Central Line Associated Blood Stream Infections • Injuries from Falls and Immobility • Obstetrical Adverse Events • Pressure Ulcers • Surgical Site Infections • Venous Thromboembolism • Ventilator-Associated Pneumonia • Preventable readmissions

21. Medicare All Cause, 30 Day Hospital Readmission Rate

22. Partnership for Patients: Over 3500 Hospitals Reducing Harm and Improvement Accelerating

23. The “3T’s” Road Map to Transforming U.S. Health Care Improved health care quality & value & population health Basic biomedical science Clinical efficacy knowledge Clinical effectiveness knowledge T1 T2 T3 Key T1 activity to test what care works Clinical efficacy research Key T2 activities to test who benefits from promising care Outcomes research Comparative effectiveness Research Health services research Key T3 activities to test how to deliver high-quality care reliably and in all settings Quality Measurement and Improvement Implementation of Interventions and health care system redesign Scaling and spread of effective interventions Research in above domains Source: JAMA, May 21, 2008: D. Dougherty and P.H. Conway, pp. 2319-2321. The “3T’s Roadmap to Transform U.S. Health Care: The ‘How’ of High-Quality Care.”

24. Future Vision • Technology and innovation focused on eliminating patient harm • Best practices spread rapidly • Payment and incentive systems reward eliminating harm and improved patient outcomes • Electronic health records, monitoring, and data analytics utilized to drive improvement • Learning from other industries (e.g., reliability science, LEAN, etc) applied to health care • Systems redesign achieves better health, better care, and lower costs through improvement

25. Contact Information Dr. Patrick Conway, M.D., M.Sc. CMS Chief Medical Officer CMS Deputy Administrator for Quality and Innovation 410-786-6841Patrick.conway@cms.hhs.gov

26. Patient Safety Science & Technology Summit2014