1 Strategies Today for Higher Quality Tomorrow Brady Augustine Senior Executive for ESRD Program & Acting Director, DCCP March 25, 2004

Pursuing Excellence

ESRD Stakeholders Meeting 3 CMS Approach to Quality Secretary Thompson announces HHS Healthcare Quality Initiative (Nov 2001): Stimulate / support providers & clinicians to improve the quality of health care Empower consumers to make more informed decisions regarding their healthcare

ESRD Stakeholders Meeting 4 4 WHAT WE CAN DO TO IMPROVE QUALITY IDENTIFY IMPROVEMENT OPPORTUNITIES AND SELECT APPROPRIATE IMPROVEMENT INTERVENTIONS ADOPT OR DEVELOP MEASURES COLLECT & ANALYZE DATA SELECT PRIORITY AREAS MANAGE PROCESS IN PARTNERSHIP WITH STAKEHOLDERS ESTABLISH & ENFORCE STANDARDS STRUCTURE COVERAGE AND PAYMENTS TO IMPROVE CARE SUPPORT STANDARD METHODS GIVE CONSUMERS INFOR- MATION AND ASSISTANCE TO MAKE CHOICES PROMOTE OR CREATE COLLABORA- TIONS AND PARTNER- SHIPS GIVE PLANS, DOCTORS & PROVIDERS TECHNICAL ASSISTANCE REWARD DESIRED PERFORM- ANCE

ESRD Stakeholders Meeting 5 CMS Quality Initiatives Nursing Homes – launched November 2002 Home Health – launched November 2003 Hospitals – developmental – 2004/2005 ESRD – developmental

ESRD Stakeholders Meeting 6 Comparative Quality Information Medicare Personal Plan Finder Dialysis Facility Compare Nursing Home Compare Home Health Compare – 2003 Hospital Compare – 2004/2005

ESRD Stakeholders Meeting 7 A focus on consumer information, complemented by additional tactics ESTABLISH & ENFORCE STANDARDS REWARD DESIRED PERFORM- ANCE SUPPORT STANDARD METHODS GIVE CONSUMERS INFOR- MATION AND ASSISTANCE TO MAKE CHOICES PROMOTE OR CREATE COLLABORA- TIONS AND PARTNER- SHIPS GIVE PLANS, DOCTORS & PROVIDERS TECHNICAL ASSISTANCE STRUCTURE COVERAGE AND PAYMENTS TO IMPROVE CARE

ESRD Stakeholders Meeting 8 Support Standard Methods Clinical Performance Measures Core Data Set ESRD CAHPS Survey ESRD Networks – performance based contracting

ESRD Stakeholders Meeting 9 Promote or Create Collaborations and Partnerships ESRD Open Door Forum ESRD Stakeholder Meetings Technical Expert Panels Fistula First Project Advisory Board for new Expanded Bundle Demonstration

ESRD Stakeholders Meeting 10 Provide Technical Assistance ESRD Networks State Survey Agencies

ESRD Stakeholders Meeting 11 – Dialysis Facility Compare Website – Publications – Medicare coverage information – Medicare eligibility tool – Other Compare Tools Give Consumers Information and Assistance to Make Choices

ESRD Stakeholders Meeting 12 Reward Desired Performance ESRD Disease Management Demonstration

ESRD Stakeholders Meeting 13 Structure Coverage and Payment to Improve Care HMA (Hematocrit Measurement Audit) Program Memorandum National Coverage Determination Process Evaluation of Vascular Access Payment Policy Change in Monthly Capitation Payment for nephrologists

ESRD Stakeholders Meeting 14 Establish and Enforce Standards ESRD Conditions for Coverage Survey and Certification – Increased funding – Increased training – Improved consistency – Improved accuracy

ESRD Stakeholders Meeting 15 Medicare Modernization Act (2003) IOM report on performance measures (Sec. 238) – Evaluate leading health care performance measures – Identify and prioritize options to implement policies that align performance with payment under the Medicare Program

ESRD Stakeholders Meeting 16 Medicare Modernization Act (2003) Payment for Renal Dialysis Services (Sec. 623) – Increases base composite rate by 1.6% (2005+) – OIG report on acquisition price for drugs (Apr 2004) – Basic case-mix adjusted payment system that includes add-on of “spread” between acquisition and 95% AWP for separately billable drugs (2005+) – Report to Congress on expanded bundle (Oct 2005) – Demonstration project for expanded bundle ( )

ESRD Stakeholders Meeting 17 Medicare Modernization Act (2003) Medicare Care Mgmt Performance Demo (Sec. 649) – Demonstration program for physicians – Includes quality incentives – Emphasizes health information technology and evidence-based outcomes measures – 3 years and 4 sites – Eligible beneficiaries have 1 or more chronic medical conditions

ESRD Stakeholders Meeting 18 Medicare Modernization Act (2003) Chronic Care Improvement in FFS (Sec. 721) – Requires the Secretary to phase in chronic care improvement programs in fee-for-service – Phase I: develop, test, and evaluate care improvement programs using RCT Eligible beneficiaries have 1 or more chronic conditions (such as CHF, diabetes, chronic obstructive pulmonary disease (COPD) or others as selected by the Secretary 10 sites consisting of 30,000 beneficiaries each – Phase II: expand successful efforts nationwide

ESRD Stakeholders Meeting 19 More Information on the Quality Initiatives and ESRD For more information: – Comparative databases for NH, HH, M+C, Dialysis Facilities