Better Odds for Surviving Complex Surgery

June 13, 2011

By RONI CARYN RABIN

The odds that a Medicare patient will die after undergoing one of eight high-risk operations have fallen sharply, an analysis of medical records has found.

Fewer hospitals are performing these procedures, and the hospitals that do them are high-volume facilities that tend to have more experience caring for high-risk patients, the researchers found. But that trend does not fully account for the decline in deaths.

Patients who had surgery to repair abdominal aortic aneurysms experienced the steepest decline in mortality in the analysis. Their death rate fell to 2.8 percent in 2007-8 from 4.4 percent in 1999-2000 — a 36 percent drop, due mostly to new medical technology, the researchers said.

Death rates also fell among patients after operations to treat cancers of the esophagus, pancreas, lung and bladder, and among those who had had coronary artery bypass grafting, aortic valve replacement and carotid endarterectomy, according to the study, published this month in The New England Journal of Medicine.

The declines in mortality translate into about 2,000 fewer deaths each year, said Dr. John D. Birkmeyer, director of the Center for Healthcare Outcomes and Policy at University of Michigan and the paper’s senior author. Much of the improvement stems from a new emphasis on patient safety, Dr. Birkmeyer added.

Get Free Help Finding Insurance

• If you're having trouble finding, keeping or using health insurance, your state has a free Consumer Assistance Program (CAP) that can help.

  Even if you already have insurance, it's not always easy to read the fine print and get the benefits your paid for. Here's what your CAP can do for you:

  • Help you find a health insurance plan or policy
  • File a complaint or appeal
  • Learn about your rights and new industry reforms

  Learn more at www.healthcare.gov.

‘Ask Medicare’ 2.0

What is Ask Medicare?

Ask Medicare is a one-stop source of information and support just for caregivers like you. If you're one of the nearly 66 million Americans caring for an aging, seriously ill, or disabled family member or friend, we're here to help make your life a little easier.
Learn More

April 18, 2011, 11:36 am

By PAULA SPAN

Medicare.gov gets up to 2.8 million visitors a month who use the Web site to do everything from ordering new cards to learning how many problems inspectors found at local nursing homes.

But Ask Medicare, the section devoted to family caregivers, has been drawing far less interest. Though the information it provides is comprehensive and valuable, the section was “hard to navigate and hard to read,” said Brian Smart, account manager for the Centers for Medicare and Medicaid Services.

So Medicare spent months revamping Ask Medicare, and the new and improved version made its debut last week. “My goal was to make it as easy and quick to use as possible,” said Aaron Murphy, who designed the new site. “This is already a stressful process, and people don’t have a lot of time on their hands.”

On the revamped Ask Medicare, you can sign up for an e-mail newsletter that alerts you to changes and new benefits. You can read other caregivers’ stories and share your own.

Basic information on eligibility and coverage, directions on filing claims, updates on common diseases and conditions, links to many other organizations and agencies, downloadable fact sheets and pamphlets — it’s a trove. Take a look.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Improving Care for People with Medicare

April 4, 2011 by Centers for Medicare & Medicaid Services

By Don Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services. Crossposted from HealthCare.gov

If you or a loved one has ever had the unfortunate experience of having a chronic or serious illness, you’ve experienced the frustration of our fragmented health care system. Just when you are feeling your worst, there you are in the doctor’s office or hospital room, repeating the same information time and time again, sitting through the same medical test more than once, and trying to track down lost or unavailable medical charts. These are all aspects of our current health care system we could each do without.

This can be a particular problem for the more than half of Medicare beneficiaries with five or more chronic conditions such as diabetes, arthritis, and kidney disease. These patients often receive care from multiple physicians and in multiple sites. A failure to coordinate care can lead to patients not getting the care they need or receiving duplicative care. This lack of coordination also increases their risk of suffering medical errors, such as receiving prescriptions for medications that ought not to be taken together. It can also cause complications that lead to needless hospital stays. Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days – a readmission many patients could have avoided if their care outside of the hospital had been better coordinated.

Improving coordination and communication among physicians and other providers and suppliers will help improve the care Medicare beneficiaries receive, while also helping lower costs. Numerous studies have shown that better care often costs less, because coordinated care helps to ensure that the patient receives the right care at the right time.

Thanks to the Affordable Care Act, the Department of Health and Human Services (HHS) today released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs are designed to create and support a team of health care providers who treat individual patients by working together across care settings.

Over the last months, CMS has conducted extensive outreach to patient advocates, doctors, nurses, hospitals, health plans, employers, and other interested stakeholders to hear their thinking about the best way to shape this effort. We will continue to seek feedback on the proposed rules released today so that the final rules reflect the broadest consensus on how to improve care for people with Medicare and to provide a model for private payers to draw upon. We look forward to working with patients and care providers to build the most patient friendly and cost-effective health care system achievable

Under the proposal, ACO teams of doctors, hospitals and other health care providers and suppliers working together would coordinate and improve care for patients with Original Medicare. ACOs would have to meet high quality standards in five key areas:

•Patient/Caregiver Experience of Care
•Care Coordination
•Patient Safety
•Preventive Health
•At Risk Population/Frail Elderly Health

An ACO will be rewarded for providing better care and investing in bettering the health and lives of patients. ACOs are not just a new way to pay for care. They are a new model for the organization and delivery of care. Accountable Care Organizations are designed to lift the burden of fragmented and disconnected care from patients, while improving the partnership among patients, doctors, hospitals and other providers of care in making health care decisions.

To read more on this, check out the fact sheet. You can also read my blog at the New England Journal of Medicine.

Paying Hospitals for Quality Care

May 2, 2011 by Centers for Medicare & Medicaid Services Leave a Comment

By Don Berwick, Administrator, Centers for Medicare & Medicaid Services. Crosspost from Healthcare.gov

America has a skilled health care workforce and great hospitals. Every day, our health professionals are committed to improving care processes and systems for patients. Health care professionals have been encouraging Medicare to update payment procedures for a long time; validating the quality of care they provide to patients over the quantity. By improving transparency, we are envisioning a health system where all Americans get the best possible care. So how will your doctor, your hospital, and Medicare align to fight disease and provide you with the best possible care?

Today, the Department of Health and Human Services (HHS) announced the Hospital Value-Based Purchasing Program, created under the Affordable Care Act. This program provides hospitals with incentive payments based on their performance on a number of health care quality measures. These quality measures include:

•How quickly do heart attack patients receive potentially life-saving surgery?
•How often do patients with heart failure get the discharge instructions they need to help them care for themselves?
•How satisfied are patients with their experience of care at the hospital?

This is an important national initiative that will give hospitals greater financial incentives to continually improve how they deliver care. The better a hospital does on its quality measures, the greater the incentive payment it will receive from Medicare under the initiative. This will help improve the odds that every patient receives the best care, regardless of the location of treatment. It also encourages “patient-centered” care. The Hospital Value-Based Purchasing Program captures information about patient satisfaction with their care. It asks the important questions about how well hospital staff communicated with patients during and after a hospitalization and the overall cleanliness of the hospital environment.

As the largest payer for hospital services, Medicare is in a special position to reward hospitals for looking for ways to improve how a patient experiences an inpatient stay. The new program encourages hospitals to adopt practices that have been shown to be effective in improving patient outcomes. Equally important, it will be looking very carefully at whether the patient feels that he or she has been treated with respect and compassion, and has been given the opportunity to participate in decisions about treatment.

Are you wondering how your local hospital measures up? Well, you can head to www.HealthCare.gov/compare/ to find the Hospital Compare Care Quality tool to find out how hospitals across the country are doing on 44 different care quality measures.

The Hospital Value-Based Purchasing Program is just one part of a broad-ranging effort by the Obama Administration to improve the quality of health care for all Americans, using important new tools provided by the Affordable Care Act – including the Partnership for Patients.

Through this program, Medicare is helping to improve patient safety and quality of care. The time has come for all of us to be on the same page and distinguish adequate care from excellent care. This payment plan places the patient at the center of care. Hospitals are now paid for how well they provide care, and more importantly, how well the patient does under their care. Together with our vigilant healthcare work force, hospitals will be able to continue to find ways to provide even more excellent care to every one of their patients.

To learn more about Hospital Value-based Purchasing, please visit this page.