December 2016 preview: Increased transparency and quality information via new Compare sites and data updates

By: Patrick Conway, MD, MSc, CMS Acting Principal Deputy Administrator and Chief Medical Officer and Kate Goodrich, M.D., M.H.S., Director, Center for Clinical Standards & Quality, CMS

The Centers for Medicare & Medicaid Services (CMS) continues to work diligently to make health care quality information more transparent and understandable for consumers. At CMS, one of our top priorities is to help individuals make informed health care decisions for themselves or their loved ones based on objective measures of quality. The CMS Compare websites are reliable sources of information where individuals can compare the quality of health care providers, facilities, and health plans, highlighting that people have a choice in their care.

Here’s a brief overview of some important new updates to CMS Compare websites:

Launching Inpatient Rehabilitation Facility Compare and Long-Term Care Hospital Compare websites

Today, as part of our continuing commitment to greater data transparency, CMS unveiled new Compare websites for both Inpatient Rehabilitation Facilities (IRFs) and Long-Term Care Hospitals (LTCHs). IRFs are free standing rehabilitation hospitals and rehabilitation units in acute care hospitals (and critical access hospitals). They provide intensive rehabilitation services using an interdisciplinary team approach.  LTCHs are certified as acute‑care hospitals, but focus on patients who, on average, stay more than 25 days and need extended hospital-level care. Many of the patients in LTCHs are transferred there from an intensive or critical care unit.

Under the Affordable Care Act, both IRFs and LTCHs are required to report quality data to CMS on a number of quality measures and health outcomes. These new tools take this data and put it into a format that can be used more readily by the public to get a snapshot of the quality of care each hospital provides. For instance, these tools will help families compare some key quality metrics, such as pressure ulcers and readmissions, for over 1,100 IRFs and 420 LTCHs across the nation. Specifically, the following quality measures will be reported on the new Compare sites for IRFs and LTCHs, respectively:

IRFs

• Percent of Residents or Patients with Pressure Ulcers that are New or Worsened (Short Stay) (National Quality Forum #0678)
• All-Cause Unplanned Readmission Measure for 30 Days Post-Discharge From Inpatient Rehabilitation Facilities (National Quality Forum #2502)

LTCHs

• Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (National Quality Forum #0678)
• All-Cause Unplanned Readmission Measure for 30 Days Post-Discharge from Long-Term Care Hospital (National Quality Forum #2512)

These websites reflect current industry best practices for consumer-facing websites and will be optimized for mobile use. Visit https://www.medicare.gov/inpatientrehabilitationfacilitycompare/ and https://www.medicare.gov/longtermcarehospitalcompare/ to view the new Compare sites.

For more information on IRFs and LTCHs, visit the IRF Quality Public Reporting and the LTCH Quality Public Reporting webpages.

Other CMS Compare websites include: Hospital Compare; Physician Compare; Nursing Home Compare; Medicare Plan Finder; Dialysis Compare; and Home Health Compare.

Hospice Care Quality Data

National averages of the quality measure scores of Medicare-certified hospices will be available soon on the Hospice Data Directory on data.medicare.gov. National average data will be available for two quality of care datasets – the Hospice Item Set (HIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey. The HIS reflects provider performance on the seven National Quality Forum-endorsed quality measures from July 2015 through June 2016. The CAHPS® Hospice Survey scores are calculated from survey responses that reflect care experiences of informal caregivers (i.e., family members or friends) of patients who died while in hospice care from April 2015 through March 2016.

Hospice Compare will be available in summer 2017.

For more information, visit the Hospice Quality Reporting webpage.

Hospital Compare Updates

After releasing the Overall Hospital Quality Star Rating for the Hospital Compare website in July, we will be updating that overall data to reflect refreshed measure data. This update includes a refresh of the Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) data; five new oncology care measures that were added to the Prospective Payment System-Exempt Cancer Hospital Reporting Program; and the addition of a readmission after coronary artery bypass graft surgery measure to Hospital Readmission Reduction Program. In addition to other new measures, and the removal of several measures from Hospital Compare, Veterans Health Administration (VHA) data is now available on data.medicare.gov.

Physician Compare Update and Redesign

Finally, CMS will also be adding new quality data and other information to the Physician Compare website. As part of a phased approach to public reporting, CMS is now preparing to include a significantly larger and more diverse set of quality information for group practices, individual clinicians, and Accountable Care Organizations on the Physician Compare website. This will help people with Medicare coverage to better evaluate data for more group practices and clinicians across a range of specialties.

Additionally, CMS will be releasing a new user-focused redesign of Physician Compare. The look and feel will be similar to the newly launched IRF Compare and LTCH Compare websites.

The redesign is based on extensive consumer testing and reflects current industry best practices for consumer-facing websites to make them more user friendly and intuitive. The website will be more streamlined and also be optimized for mobile use.

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Consumers have many options when choosing a health care provider. Providers vary in the quality of the care they give, and everyone wants to choose the provider who will be best for themselves or their loved ones. Yet frequently the choice must be made quickly and without the time for consumers to locate and review a wide range of information sources. Our goal with these Compare websites is to provide the public with information that they can use when making important decisions about care.

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CMS releases its Person and Family Engagement Strategy

By: Kate Goodrich, MD MHS, Director, Center for Clinical Standards and Quality, CMS

At the Centers for Medicare & Medicaid Services (CMS), we are working with numerous partners to transform our health care delivery system to one that delivers better health outcomes while spending dollars more wisely. In November of 2015, we updated the CMS Quality Strategy, incorporating the ongoing work to shift Medicare from paying for the number of services provided to paying for better outcomes for patients. We know that a key strategy to achieving better outcomes is to meaningfully engage patients as partners in decisions about their health care. Therefore, one of the six goals outlined in this strategy is: Strengthen person and family engagement as partners in care. Today, we are excited to announce the release of the CMS Person and Family Engagement Strategy, which we believe can lead to significant progress toward this important goal.

What does person and family engagement mean? We view this as patients and families being part of the health care team by working collaboratively with their doctor or other health care professional to be active partners when making decisions about their health.

Why is this important? Because consideration of the health, values, and goals of the individual in consultation with the entire health care team leads to an improved experience and better care. When people feel responsible for their own health and are partners with their providers in goal-setting and decision-making, they are much more likely to achieve their health care goals.

• If individuals feel their beliefs, desires, and culture are considered in their care, they are more likely to follow their care plan.
• If individuals are able to communicate effectively with their providers and have a prominent role in making health care decisions, they will receive better care, can more effectively manage their health, and may receive appropriate preventive care while relying less on emergency or urgent care[1].

The CMS Person and Family Engagement Strategy will serve as a guide for the implementation of person and family engagement principles and strategies throughout CMS programs. This strategy will expand the awareness and practice of person and family engagement by providing the following goals and objectives:

• Goal 1: Actively encourage person and family engagement along the continuum of care within the broader context of health and well-being in the communities in which people live.
• Goal 2: Promote tools and strategies that reflect person and/or family values and preferences and enable them to actively engage in directing and self-managing their care.
• Goal 3: Create an environment where persons and their families work in partnership with their health care providers to develop their health and wellness goals informed by sound evidence and aligned with their values and preferences.
• Goal 4: Develop meaningful measures and tools aimed at improving the experience and outcomes of care for persons, caregivers, and families. Also, identify person and family engagement best practices and techniques in the field that are ready for widespread scaling and national integration.

This Strategy emphasizes that person and family engagement goes beyond informed consent. It is about including the patients voice in policy and program planning. It is about proactive, effective communication and partnered decision-making with patients, families, and caregivers. It is about building a care relationship based on trust and inclusion of patients’ beliefs, values, preferences, and culture which can even lead to a reduction in health care disparities. Health care decision-making should not always be limited to the patient and provider. It is essential to include family members, care-givers, and close friends in the conversation about health when the patient desires inclusion of others. As delivery system reform efforts move the nation to focus on the quality of care and not the quantity of care received, person and family engagement is an essential part of a health care system that delivers high quality care, spends dollars more wisely, and improves the health of people in their communities.

[1] Epstein RM, Street RL, Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. National Cancer Institute, NIH Publication No. 07-6225. Bethesda, MD, 2007.