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What does the National Healthcare Agenda Mean to Us?. Developed in cooperation with Patricia C. Kienle, MPA, FASHP and Wayne S. Bohenek, Pharm.D., M.S., FASHP Reviewed July 2009. What do we mean by “Quality”?. Safe - avoiding injuries to patients from the care that is intended to help them

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What does the national healthcare agenda mean to us l.jpg

What does the National Healthcare Agenda Mean to Us?

Developed in cooperation with Patricia C. Kienle, MPA, FASHP and Wayne S. Bohenek, Pharm.D., M.S., FASHP

Reviewed July 2009

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What do we mean by “Quality”?

Safe - avoiding injuries to patients from the care that is intended to help them

Effective - providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively)

Patient Centered - providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

Timely - reducing waits and sometimes harmful delays for both those who receive and those who give care.

Efficient - avoiding waste, including waste of equipment, supplies, ideas, and energy

Equitable - providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

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Stakeholder Response to Patient Safety


Mandatory requirements for accreditation






High Quality

Safe Care


Monitor provider

organizations through

mandatory and voluntary


Institution Initiatives

Specific initiatives identified by this institution.

Financial Issues

Do more with less


Provide incentives to providers that use tools to increase safety and can demonstrate performance.



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Key Organizations

  • The Joint Commission

  • Medicare (CMS)

  • Agency for Healthcare Research and Quality (AHRQ)

  • Institute of Medicine (IOM)

  • Institute for Healthcare Improvement (IHI)

  • ASHP 2015

  • National Quality Forum (NQF)

  • The Leapfrog Group

  • Quality Alliances

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The Joint Commissionwww.jointcommission.org

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National Quality Forum www.qualityforum.org






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www.hospitalcompare.hhs.gov and www.medicare.gov

  • Hospital Quality Alliance (HQA)


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Quality Drivers

  • External drivers

    • Core Measures

    • Surgical Care Improvement Project

    • IHI 5 Million Lives campaign

    • Public reporting

    • Medicare stop payment for errors

  • Internal drivers

    • Pay for Performance (P4P) initiatives

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Quality Indicators

National Goals

Measure Development

NQF Endorsement

Measure Selection

Data Collection, Aggregation, Verification

Public Reporting and Accountability

Quality Improvement

Were the goals achieved?

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Annual Payment Update

Hospital Quality Alliance

Joint Commission


Growth of Publicly Reported Measures

2004 – Annual Payment Update of .4% tied to submitting 10 HQA measures

2007 – Annual Payment Update of 2% tied to submitting 21 HQA Measures and CMS able to add additional measures; HCAHPS next.






Number of Measures







Jul 06

Apr 05

Oct 06

Oct 07

Mar 07

Sep 05

Nov 04

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Performance (Core) Measures

  • Acute Myocardial Infarction (AMI)

  • Heart Failure (HF)

  • Pneumonia (PN)

  • Pregnancy and related conditions (PRC)

  • Surgical Infection Prevention(SCIP)

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Acute Myocardial Infarction

  • Thrombolytics

    • Time to administration

  • Drugs at discharge

    • Aspirin

    • ACE inhibitor or ARB for left ventricular systolic dysfunction

    • Beta blocker

  • Adult smoking cessation counseling

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Surgical Care Improvement Project

  • Project Goal: decrease incidence of surgical complications by 25% by 2010

  • SCIP

    • Cardiac

    • Infections

    • Respiratory

    • Venous Thromboembolism

    • End-Stage Renal Disease

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  • Cardiac

    • Beta blockers

  • Infections

    • Surgical site infections

  • Respiratory

    • Post-operative pneumonia

  • Venous thromboembolism

    • Prophylaxis

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Pay for Performance (P4P)

  • “Groundbreaking . . . Pay for performance should become a top national priority”

    • Open letter in Health Affairs signed by 15 leaders in the quality movement.

  • “I would like to see 5,000 hospitals participating.”

    • Tom Scully in Modern Healthcare

  • “Fix For a Sick System”

    • InformationWeek

Source: Premier, Inc

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Condition X

Condition X

Condition X

1st Decile

2nd Decile

1st Decile

3rd Decile


4th Decile

1st Decile

2nd Decile

Top Performance Threshold

5th Decile

3rd Decile

6th Decile

2nd Decile

4th Decile

7th Decile

5th Decile

8th Decile

3rd Decile

9th Decile

6th Decile

4th Decile

10th Decile

7th Decile


5th Decile

8th Decile

9th Decile

6th Decile

10th Decile

7th Decile

Payment Adjustment Threshold


8th Decile

9th Decile

10th Decile

Year Three

Year One

Year Two

Anticipated Payment Scenario

Source: Premier, Inc

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Centers for Medicare and Medicaid (CMS)

Outpatient Quality Reporting Measures for 2009

  • Hospitals will be asked to report the following measures, mostly for ED and Ambulatory Surgery patients:

  • OP-1 ACEI or ARB for LVSD prescribed for patients with heart failure

  • OP-2 HgA1c poor control in Type 1 or 2 diabetes mellitus measured during

  • the last 12 months

  • OP-3 Empiric antibiotic selection for community-acquired pneumonia

  • (CAP) in immunocompetent patients

  • OP-4 Prophylactic antibiotic initiated within one hour prior to surgical

  • incision

  • OP-5 Prophylactic antibiotic selection for surgical patients

  • OP-6 Aspirin at arrival

  • OP-7 Median time to fibrinolysis

  • OP-8 Fibrinolytic therapy received within 30 minutes of ED arrival

  • OP-9 Median time to ECG

  • OP-10 Median time to transfer to another facility for acute coronary

  • intervention

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What’s Next?

  • Tight glycemic control

  • Asthma care

  • Stroke management

  • Diabetes

  • ?

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Understand the National Healthcare Agenda

Understand How this Institution Prioritizes the National Agenda

Develop and Align Our Pharmacy’s Programs Accordingly

Influence you Facility’s Strategic Direction

Develop Skills in Performance Improvement

And Change Management