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    Quality, performance measures make haste slowly

    CMS rolls out initiatives to report errors, measure quality


    Bob Gatty
    Washington—In November 1999, the Institute of Medicine (IOM) reported that as many as 98,000 Americans were being killed each year by medical mistakes and made recommendations it said could slash that rate in half within 5 years.

    Despite a flurry of publicity and activity, including congressional hearings and increased funding for patient safety research, it hasn't happened, acknowledged Lucian Leape, MD, adjunct professor of health policy at the Harvard School of Public Health in Cambridge, MA, and a member of the IOM study committee that produced the report.

    "The challenge still remains to ramp up efforts on a national scale, to generate stronger institutional leadership, and to spread the culture of quality to all organizations and individuals in the health care community, as well as to the policy makers who make decisions and appropriate funding related to health care," he said in an article published by IOM (JAMA 2005; 293:2384-90).

    "We didn't get the 50% reduction in medical errors within 5 years that we had hoped for. But we now have a vision in place; we're learning what works; and we're starting to translate more and more plans into actions. With proper leadership, it just may be possible to reach the initial error-reduction goal—and even do better—in the not so distant future."

    Reforms underway

    Meanwhile, major developments are now underway that will affect all physicians, including urologists, in 2006.

    Last July, Congress approved the Patient Safety and Quality Improvement Act, designed to encourage hospitals and health care providers to voluntarily report medical errors, serious adverse events, and their underlying causes to private patient safety organizations that contract with hospitals or other health care organizations to analyze their mistakes and develop methods of prevention.

    Last month, the Centers for Medicare & Medicaid Services was to launch the Physician Voluntary Reporting Program (PVRP) to analyze the quality of care provided to Medicare beneficiaries by using a set of quality "G-codes" established by Medicare. Physicians will be asked to use these non-specialty-specific codes within the existing administrative system for their claims. (For details, visit http://www.cms.hhs.gov/PhysicianFocusedQualInits/)

    Fast Facts
    The PVRP is part of the agency's Physician Focused Quality Initiative, which also includes the Doctors Office Quality Project, designed to develop and test a comprehensive, integrated approach to measuring the quality of care for chronic disease and preventive services in physicians' offices. Its goals are to provide information for informed decision-making and to support and stimulate adoption of quality improvement strategies by practitioners in doctors' offices.

    CMS says it is working closely with "key stake holders," such as physician associations, consumer advocacy groups, philanthropic foundations, purchasers, and quality accreditation and quality assessment organizations, to develop and test the effectiveness of the project.

    All of this is taking place as efforts to implement a new pay for performance system for Medicare reimbursement are being pushed by CMS and its advocates in Congress.

    Last November, CMS Administrator Mark B. McClellan, MD, PhD, told the House Energy and Commerce Health Subcommittee that the system is broken and must be overhauled, that physicians face steep Medicare payment cuts over the next several years, and that taking arbitrary action to block those cuts won't work. A new system to reimburse physicians based on their efficiency and quality of care is needed, he declared.


    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.