MBGH Update: Methodist Healthcare Quality Report Cards Now On-line

Memphis Business Group on Health (MBGH) applauds Methodist Le Bonheur Healthcare (Methodist) for making their quality of care report card public on their websites. Specifically, MBGH is pleased with this initiative for the following reasons:

• MBGH has been working with Memphis-area hospitals since 1997 to improve transparency. As advocates for our member employers, we’ve consistently pressured hospitals to measure and publicly report their performance and to use this information to improve the quality of care they provide.

• MBGH has been asking Methodist to report quality information separately for their adult hospitals since 2002. In response to our request for Methodist to participate in our Leapfrog initiative, they have responded to The Leapfrog Group Annual Hospital Survey separately for each adult hospital. Until now, other publicly available quality reports have only been at the system level, essentially reporting average performance across the system. System-level reporting has not been useful to employers as they try to educate their employees about selecting hospitals that provide higher quality care. In this new initiative, Methodist is reporting quality information by facility which is a significant advancement.

• MBGH has asked Memphis-area hospitals to report their performance on a regular basis, which allows employer purchasers and employees to track performance over time, including whether hospitals improve performance or if there is lack of improvement. Methodist has committed to reporting this information regardless of whether it shows they are providing quality care or if they need to improve, thereby providing the good news and the not-so-good news.

This initiative is an excellent first step in increasing transparency with area employer purchasers and employees/potential patients. MBGH asks that all Memphis-area hospitals look to this as a local transparency standard they should try to meet and exceed.

As this initiative takes root, MBGH asks all Memphis-area hospitals, including Methodist, to add additional critical information to their online information. Information on outcomes, such as survival rates/mortality rates; structure measures such as staffing in ICUs and computerized physician order entry; and hospital acquired conditions, such as falls, pressure ulcers, and infections is already available and would not require significant work to add to the reports.

Gary Shorb, President and CEO of Methodist Le Bonheur Healthcare, emphasizes their commitment to working with MBGH and purchaser employers to provide additional information that is useful to employers and their employees. MBGH is meeting with Gary and senior Methodist staff to work out the specifics and timeline. We will keep you up-to-date as details are finalized.

We welcome the opportunity to work with other Memphis-area hospitals, as well, as they develop their transparency strategies.

In the meantime, we encourage you to access and use the Methodist Healthcare information by clicking below:

Methodist Healthcare Adult Quality

Le Bohneur Children’s Hospital Quality

MBGH Participating in TN's All Claims Database Development

 MBGH is a member of the Tennessee Health Information Committee which oversees the development of TN's all claims database in terms of information that is collected and information that is publicly reported.

Click here to read a report which summarizes why states are creating these all claims databases. Examples of how information from these databases can be used include:

• Employers can begin to understand the variation in cost and utilization by geographic area within a state;
• The value equation (cost & quality) of new health care services can be assessed;
• The design and implementation of health reforms can be informed by data and data can be tracked to determine impact;
• Compare prevalence of disease across populations;
• Determine payer competitiveness;
• Report on the cost and quality of individual providers. 

TN's all claims database is currently in the data collection process and the first public reports are expected in 2011. MBGH will keep your members informed as information becomes available.

Memphis Medical News Reports on MBGH Leapfrog Rewards

Click here for the Memphis Medical News article on MBGH's April Annual Awards Luncheon where we recognized hospitals for their national performance and "best odds of survival".

Memphis Hospitals Continue to be Challenged by Infections

Click here to read the latest article on hospital infection rates in Memphis.

MBGH has been working through The Leapfrog Group and other ways to push hospitals to reduce hospital infections, which cost both dollars and lives.

Click here to see Leapfrog Hospital Survey results for Memphis hospitals which include infectionr rates in ICUs. Share this important information with your employees so they can select hospitals that provide a higher level of quality, safe care.

Pushing for Market-Level Health Plan Performance Reporting

I attended my first NCQA Purchaser Advisory Council today and it was a great meeting. NCQA is addressing the latest in health reform issues, including exchanges, accountable care organizations, relative resource use and furthering its work in wellness/health promotion and medical home. I am excited about the tools and information NCQA is working on, most of which measure and report performance at a plan or vendor level.

But I am struck by the fact that although reporting at the plan or vendor level often works for individual employers, those of us involved in community-level change need this valuable information cut in a different way. For example, health plans in TN report their HEDIS measures at a statewide level. Works for employers that have employees across the state, but does not work for those of us wondering how plans are peforming in Memphis specifically. Another example is the wealth of information that will become available through NCQA's relative resource use reports, which, once again, look at the plan's performance across the entire state.

It is great to know how health plans perform, in general across TN, but it would be even more powerful and actionable to know how they perform in each market in TN. That would tell us more about our own providers and their performance and help identify what we need to improve locally and may even give us hints about how to improve it. Because of contracting methods here in Memphis, where plans contract either with Baptist or Methodist, but generally not with both, we could even begin to understand if there are any real differences in the quality and resource use between our two major hospital systems and their affiliated physicians.

Understanding whether these differences exist between Baptist & Methodist is critical to local employers, and their employees, in knowing where to go for safe, high quality, efficient care.

NCQA is pushing itself to be relevant, vital, and address the current issues that are even more important due to health reform. The next challenge will be how to make this information relevant and usable by communities as well as individual employers. I hope I can bring this perspective to NCQA as I continue to serve on their Purchaser Advisory Council.

MBGH Recognizes 5 Memphis-area Hospitals for "Best Odds of Survival"

Click here to read about MBGH's Leapfrog awards to 5 Memphis-area hospitals that have "best odds of survival" in the Memphis Daily News.

Click here to read the press release which talks about other Memphis-area findings from the Leapfrog Hospital Survey, including how Memphis hospitals compare to hospitals nationally on COST of care.

MBGH Presents on Health Reform to Tennessee Personnel Management Assoc.

Click here to check out MBGH's Health Reform presentation to the Tennessee Personnel Management Association on April 15, 2010 for a reminder on why there was such a push for health reform, how we got health reform, how what we got addressed the issues that pushed reform to happen, and some key provisions impacting employers.

The VA Saves $3 Billion over 10 Years with HIT Systems

The VA system reports that implementing health information technology has saved them $3billion from 1997-2007 through reductions in duplicated tests and medical errors, as well as operating efficiencies. Technology implemented included computerized patient records, bar coded medications, radiology, laboratory and medication ordering. Imagine the savings we could have in Memphis if all of our systems implemented these same technologies!!! Quality of care also improved during this period. You can track Memphis hosptial progress in implementing computerized provider order entry for medications by reviewing The Leapfrog Hospital Survey results here (see "Prevent Medication Errors"). We have a long way to go in this area. Methodist Healthcare indicates that Methodist North and Le Bonheur are now operational and the remainder of the system should be operational by 2011.

Click here to read an article about the VA experience.

Employers: Focus on These Aspects of Health Reform NOW!!!

Click here to hear Steve Wojcik, vice president of public policy for the National Business Group on Health, offer his take on what employers should have top of mind between now and when the biggie components of the Patient Protection and Affordable Care Act take effect in 2014 and 2018.

MBGH Says: Real Cost Reform is Still to Come

Memphis Business Group on Health's work is highlighted in the April 1, 2010 Memphis Business Quarterly blog. The posting focuses on the need for real cost reform -- saving dollars and improving quality by preventing things that should not happen and improving health and saving dollars by doing things we should be doing to take better care of ourselves.

There is also a link to the Leapfrog Hospital Survey results for Memphis hospitals.

Check the Memphis Business Quarterly blog out regularly for other Memphis business-related postings.

Not Paying for Readmissions Spurs Improvements in Patient Care

It is estimated that 75% of the Medicare admissions readmitted to the hospital within 30 days of discharge were preventable. In total, the cost of readmissions to Medicare is approximately $17.4 billion annually.

Medicare's decision NOT to pay for preventable/avoidable readmissions to hospitals has gotten attention. Significant work is now being done by hospitals to put better discharge and/or transfer processes into place to better coordinate care, ensure patients have support systems at home and get needed followup services. A good example of how aligning payments with desired outcomes serves as the main "carrot or stick" to get action. And, a good example of how poor quality care drives high cost.

Click here to read the article. The clear connection between aligning payment with expected outcomes is in the last paragrah.

Patient Safety Incidents Cost $8.9 Billion Annually

Latest Health Grade's Patient Safety in American Hospitals study finds that there was little progress in reducing patient safety incidents in hospitals for Medicare patients in 2009. They estimate that these patient safety incidents added $8.9billion to the cost of health care in 2009 and that almost 100,000 Medicare patients died as a result of these incidents.Top performing hospitals had 43% fewer incidents than poorly performing hospitals.One more example of how costly poor quality is!!!

Click here to read an article about the report.

Memphis Businesses Get Head Start on Health Reform through MBGH

Click here to read the ABC24 Eyewitness News report (aired on March 23 at 5:00) on the role MBGH plays in health reform.

In the interview, Cristie Upshaw Travis said that even though access to health care dominates the talk about health care reform, Travis said there’s more to the issue. “If we don’t pay attention to the cost and quality of services that everybody receives, we will never see an end to increased costs related to health care.”

Unnecessary Angiograms Are Very Costly to Your Health Plan

Recent study released in the New England Journal of Medicine shows that 62% of 400,000 patients that had no known heart disease and were not receiving emergency heart care had no significant heart blockage found in their angiogram results. The study suggests that physicians should do a better job of identifying those patients that need an angiogram, especially for the 20-30% of the patients that have no symptoms.

Medicare pays about $1,400 for an outpatient angiogram and $3,000 for an inpatient angiogram. Private payors typically pay more. So performing angiograms on patients that do not have significant heart blockage is very costly to you as an employer. For these 62% of the patients, payments could be an estimated $446 million (note: estimated by MBGH. Although the test may have not shown any significant blockage, it may still have been appropriate for some of these patients)

So, what can you do about this?

• Encourage your employees to discuss less invasive alternatives, and the risks associted with these as well as angiograms, with their physician.
• Check with your health plan to see what type of decision support tools they are offering your employees and how they let your employees know these tools are available. Also ask them how many employees actually use these tools.
• Consider plan design triggers that require accessing decision support services for non-emergencies through the plan prior to scheduling invasive tests.

Click here to read the Yahoo article which includes a link to the New England Journal of Medicine.

Cost Effective, Quality, Safe Care Must Be Part of the Med's Plan

Merely waiving co-pays and deductibles is not enough to accomplish what The Commercial Appeal's editorial says the Med must do: "The Med has to convince potential paying patients that it's a quality alternative for medical care."

Waiving co-pays and deductibles reduces financial barriers for patients, but in no way ensures that the care they receive is efficient, high quality, and safe. People should have information on the cost and quality of care at the Med to decide if the waived financial requirements are "worth it". But much of the cost and quality information that is available for all the other hospitals in Memphis is not available for the Med because the Med does not publicly report this information through The Leapfrog Group's Annual Hospital Survey (click here to get results for other Memphis hospitals).

Information that is publicly available on the Med's quality of care shows that significant opportunities for improvement exist. For example, recently released statistics on central line infections in ICUs shows that in 2008, the Med's rate of infection was approximately 238% above the average (click here to read Consumer Reports Health article and click here to get State of Tennessee report) . The Med indicates that they have been addressing this issue, but it would be good for us to know what progress they have made in bringing the infection rate down. If the Med reported to The Leapfrog Group survey, we would know how effective their improvement efforts have been and could track their progress.

In addition, the Med's scores on patient experience of care measures from Medicare's survey for the 12-months ending March 2009 show that only 56% of the patients would "definitely recommend" the hospital to others (compared to a national and statewide 68% average).

Finding a financial solution to the Med's situation is essential, but the Med owes us cost-effective, high quality, and safe care. They owe us this under all circumstances, but especially if they are going to offer us financial incentives to use their services. It is not right to ask people to make the decision to come to the Med based only on the fact that they will "save money". The Med should participate, as all other Memphis hospitals do, in the Leapfrog survey so people can decide if the quality of care they are likely to receive is worth saving money because there are no co-pays or deductibles.

Click here to read the latest Commerical Appeal editorial.

Handy Tool to Assess Your Dental Benefit Offerings

Check out this article which gives you an easy way to assess the quality of your dental benefits. Key aspects include:

Offering the right preventive services
Giving employees access to dental risk assessments
Maximizing flexible spending accounts
Communicating effectively with your employees

Click here for the article from Workforce.com. You will need to register, but it is free!!

More Cost-Effective Dental Benefits Now Available

Tailoring dental benefits to the needs of your employees, including medical conditions they may have such as diabetes, can help you save dollars down the road. Click here to read the Workforce.com article. You may need to register, but it is free!!

Pharmacist-based Program Proves Effective for Diabetics in Polk County, FL

An employer-based clinical pharmacist counseling program for type 2 diabetes patients in Polk County, FL led to a 9% improvement in A1C levels, a 30% decrease in hospitalizations, and a 24% decrease in ER visits. These results of this 2005 study are reported in the February 15, 2010, American Journal of Health-System Pharmacy.

The pharmacist provided six 30-minute counseling sessions and copays were waived for disease-related medications, supplies, and non-prescription products. Participants were asked to sign an agreement to comply with program rules and processes. A total of 564 enrolled in the program and 477 were still active in the program at the end of 12 months.


Click here to read the article.

Cut Cost by Reducing Hospital-Acquired Conditions: Sepsis & Pneumonia

Study results reported by Extending the Cure in The Archives of Internal Medicine indicate that patients that develop sepsis (a systemic response to infection) after surgey end up staying an extra 11 days in the hospital at an average cost of an additional $33,000. In addition, 20% of these patients die of the infection.

The study also found that patients that develop pneumonia after surgery, often due to a dirty ventialtor tube, stay in the hospital an extra 14 days and cost an additional $46,000. 11% of these patients die of the pneumonia.

According to Ramanan Laxminarayan, Ph.D., principal investigator, "In many cases, these conditions could have been avoided with better infection control in hospitals.” 

This study presents one more piece of evidence that improving the quality & safety in hospitals not only saves lives, but saves dollars as well.

Click here to read the article.

Health Plan Performance Improving Slightly for Diabetes, But More Work Needed

The National Business Coalition on Health's just released 2009 Health Plan Diabetes Performance report shows that there is only slight improvement in outreach and outcomes for diabetics in the surveyed plans. Approximately 81% of the diabetics had at least one A1C test, but approximately 43% of them had uncontrolled blood sugar levels.

These challenging outcomes exist even while large numbers of plans and their customers are using:

• Disease management
• Personal health assessments
• Gaps in care reminders for physicians
• NCQA's physician recognition program which identifies physicians with quality outcomes for their diabetic patients. 

Dennis White, Senior VP for Value-Based Purchasing at NBCH states, "Now the challenge is getting consumers engaged, using the tools, but also better coordination with employers for things like plan design and cultural reinforcement, and doctors to track and act on gaps in care.”

So, what are you doing in your plan design to help your outcomes improve?

This annual report is based upon results for the 70 health planscovering approximately 96 million Americans that particated in NBCH's 2009 eValue8 program. In Tennessee, BlueCross BlueShield of Tennessee and CIGNA Healthcare of TN provided information through Memphis Business Group on Health.

Click here to read the Business Insurance article on the report.

Click here to access a copy of the report.