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Initiatives to Improve Health Quality Focus of Subcommittee Hearing

On March 18, the House Ways and Means Subcommittee on Health heard testimony on the new frontiers in health quality initiatives.

Noting that there are “increasingly serious gaps in health quality” in the United States, Chair Nancy Johnson (R-CT) addressed a provision in the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (P.L. 108-173) that is intended to close the gap. Under the measure, hospitals are given a financial incentive to report on 10 quality indicators, such as whether a patient with an acute myocardial infarction receives a beta blocker at admission. As of February 12, 2004, more than half (2,727) of all hospitals have committed to provide public reporting on the 10 measures.

Ranking Member Pete Stark (D-CA) agreed that the nation’s quality of health care must improve. He cited a RAND Corporation study that found, “Adults receive appropriate care only half the time.”

Dr. Carolyn Clancy of the Agency for Healthcare Research and Quality (AHRQ) highlighted initiatives taken by the agency and the Department of Health and Human Services (HHS) to improve health care quality. She explained that AHRQ’s research in patient safety addresses questions about when and how medical errors occur and how science-based information can make the health care system safer. “We know…that medication errors are a major issue and have made research on the safe and appropriate use of pharmaceuticals a significant focus of our research agenda,” she stated. “For example, a recent research finding has identified a disturbingly large number of pregnant patients receiving prescriptions for drugs that are contraindicated in pregnancy. We are working with the FDA [Food and Drug Administration] and other HHS agencies to develop collaborative strategies for addressing this problem.”

Dr. Clancy noted that AHRQ also has launched an initiative to improve health care quality and reduce medical errors through the use of information technology. Under the initiative, “AHRQ will award $50 million to help hospitals and other health care providers invest in information technology designed to improve patient safety, with an emphasis on small communities and rural hospitals and systems, which don’t often have the resources or information needed to implement cutting-edge technology.”

Chair of the Medicare Payment Advisory Commission (MEDPAC), Glenn Hackbarth focused his comments on the quality of care provided to Medicare beneficiaries. Citing a number of MEDPAC studies, he stated, “Simply providing more care does not necessarily lead to improving quality…in fact it appears that states with the highest use [of care] tend to have lower quality than states with the lowest use.” Mr. Hackbarth pointed out that all health care providers “are paid the same regardless of the quality of service provided. At times providers are paid even more when quality is worse, such as when complications occur as a result of error.” He argued that Congress should establish a quality incentive payment policy for physicians and facilities in all private Medicare plans.

Dr. Sam Ho of PacifiCare Health Systems in California highlighted PacifiCare’s programs to improve health and disease management, including population-based programs such as “Taking Charge of Depression” and “Pregnancy to Preschool.” He also noted that in 2001, PacifiCare introduced the QUALITY INDEX® Profile for Women. Dr. Ho stated, “This unique report is comprised of data specific to female patients from providers in our contracted network. It measures relative provider group performance on 14 selected areas of clinical and service quality. The charts with the QUALITY INDEX® Profile for Women illustrate how provider groups address the needs of their female patients and also how satisfied the female patients are with the care they receive from their providers.” He argued that their QUALITY INDEX® Profiles have been very successful. “Providers have responded by competing and improving average mean performance in 65 percent of clinical and service measures,” he stated. “Also, members have ‘voted with their feet’ by changing to better performing providers, which, in turn, represents $18 million in additional annual capitation payments to those providers.”

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