1. What does the National Healthcare Agenda Mean to Us? Developed in cooperation with Patricia C. Kienle, MPA, FASHP and Wayne S. Bohenek, Pharm.D., M.S., FASHP Reviewed July 2009

2. What do we mean by “Quality”? Safe - avoiding injuries to patients from the care that is intended to help them Effective - providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively) Patient Centered - providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions Timely - reducing waits and sometimes harmful delays for both those who receive and those who give care. Efficient - avoiding waste, including waste of equipment, supplies, ideas, and energy Equitable - providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

3. Stakeholder Response to Patient Safety High Quality Safe Care Payers Provide incentives to providers that use tools to increase safety and can demonstrate performance. Regulatory Mandatory requirements for accreditation Government Monitor provider organizations through mandatory and voluntary reporting. Institution Initiatives Specific initiatives identified by this institution. IHI AHRQ ISMP ASHP NQF Financial Issues Do more with less Employers Leapfrog

4. Key Organizations The Joint Commission The Joint Commission Medicare (CMS) Medicare (CMS) Agency for Healthcare Research and Quality (AHRQ) Agency for Healthcare Research and Quality (AHRQ) Institute of Medicine (IOM) Institute of Medicine (IOM) Institute for Healthcare Improvement (IHI) Institute for Healthcare Improvement (IHI) ASHP 2015 ASHP 2015 National Quality Forum (NQF) National Quality Forum (NQF) The Leapfrog Group The Leapfrog Group Quality Alliances Quality Alliances

5. The Joint Commission www.jointcommission.org

6. National Quality Forum www.qualityforum.org 2003 2005 2007

9. www.hospitalcompare.hhs.gov and www.medicare.gov Hospital Quality Alliance (HQA) Hospital Quality Alliance (HQA) http://www.qualitynet.org

10. Quality Drivers External drivers External drivers Core Measures Core Measures Surgical Care Improvement Project Surgical Care Improvement Project IHI 5 Million Lives campaign IHI 5 Million Lives campaign Public reporting Public reporting Medicare stop payment for errors Medicare stop payment for errors Internal drivers Internal drivers Pay for Performance (P4P) initiatives Pay for Performance (P4P) initiatives

11. National Goals Measure Development NQF Endorsement Measure Selection Data Collection, Aggregation, Verification Public Reporting and Accountability Quality Improvement Were the goals achieved? Quality Indicators

12. 2004 – Annual Payment Update of.4% tied to submitting 10 HQA measures 2007 – Annual Payment Update of 2% tied to submitting 21 HQA Measures and CMS able to add additional measures; HCAHPS next. Growth of Publicly Reported Measures 0 5 10 15 20 25 30 35 40 45 50 Nov 04 Apr 05 Sep 05 Jul 06 Oct 06 Mar 07 Oct 07 Number of Measures Annual Payment UpdateHospital Quality AllianceJoint Commission CMS

13. Performance (Core) Measures Acute Myocardial Infarction (AMI) Acute Myocardial Infarction (AMI) Heart Failure (HF) Heart Failure (HF) Pneumonia (PN) Pneumonia (PN) Pregnancy and related conditions (PRC) Pregnancy and related conditions (PRC) Surgical Infection Prevention (SCIP) Surgical Infection Prevention (SCIP)

14. Acute Myocardial Infarction Thrombolytics Thrombolytics Time to administration Time to administration Drugs at discharge Drugs at discharge Aspirin Aspirin ACE inhibitor or ARB for left ventricular systolic dysfunction ACE inhibitor or ARB for left ventricular systolic dysfunction Beta blocker Beta blocker Adult smoking cessation counseling Adult smoking cessation counseling

15. Surgical Care Improvement Project Project Goal: decrease incidence of surgical complications by 25% by 2010 Project Goal: decrease incidence of surgical complications by 25% by 2010 SCIP SCIP Cardiac Cardiac Infections Infections Respiratory Respiratory Venous Thromboembolism Venous Thromboembolism End-Stage Renal Disease End-Stage Renal Disease

16. SCIP Cardiac Cardiac Beta blockers Beta blockers Infections Infections Surgical site infections Surgical site infections Respiratory Respiratory Post-operative pneumonia Post-operative pneumonia Venous thromboembolism Venous thromboembolism Prophylaxis Prophylaxis

17. Pay for Performance (P4P) “Groundbreaking... Pay for performance should become a top national priority” “Groundbreaking... Pay for performance should become a top national priority” Open letter in Health Affairs signed by 15 leaders in the quality movement. Open letter in Health Affairs signed by 15 leaders in the quality movement. “I would like to see 5,000 hospitals participating.” “I would like to see 5,000 hospitals participating.” Tom Scully in Modern Healthcare Tom Scully in Modern Healthcare “Fix For a Sick System” “Fix For a Sick System” InformationWeek InformationWeek Source: Premier, Inc

18. Anticipated Payment Scenario 1st Decile Hospital Year OneYear Two Year Three Top Performance Threshold Payment Adjustment Threshold 2nd Decile 3rd Decile 4th Decile 5th Decile 6th Decile 7th Decile 8th Decile 9th Decile 10th Decile 1st Decile 2nd Decile 3rd Decile 4th Decile 5th Decile 6th Decile 7th Decile 8th Decile 9th Decile 10th Decile 1st Decile 2nd Decile 3rd Decile 4th Decile 5th Decile 6th Decile 7th Decile 8th Decile 9th Decile 10th Decile Condition X Source: Premier, Inc

19. Hospitals will be asked to report the following measures, mostly for ED and Ambulatory Surgery patients: OP-1 ACEI or ARB for LVSD prescribed for patients with heart failure OP-2 HgA1c poor control in Type 1 or 2 diabetes mellitus measured during the last 12 months OP-3 Empiric antibiotic selection for community-acquired pneumonia (CAP) in immunocompetent patients OP-4 Prophylactic antibiotic initiated within one hour prior to surgical incision OP-5 Prophylactic antibiotic selection for surgical patients OP-6 Aspirin at arrival OP-7 Median time to fibrinolysis OP-8 Fibrinolytic therapy received within 30 minutes of ED arrival OP-9 Median time to ECG OP-10 Median time to transfer to another facility for acute coronary intervention Centers for Medicare and Medicaid (CMS) Outpatient Quality Reporting Measures for 2009

20. ASHP Website and 2015 Crosswalk www.ashp.org/qii

21. What’s Next? Tight glycemic control Tight glycemic control Asthma care Asthma care Stroke management Stroke management Diabetes Diabetes ? ?

22. What are we doing?

23. Summary Understand the National Healthcare Agenda Understand How this Institution Prioritizes the National Agenda Develop and Align Our Pharmacy’s Programs Accordingly Influence you Facility’s Strategic Direction Develop Skills in Performance Improvement And Change Management