Remarks to the 2010 Quality Improvement of the Year award banquet sponsored by the George Mason University College of Health and Human Services
By HRSA Administrator Mary K. Wakefield
April 22, 2010
Thank you Dr. Maddox (PJ Maddox, Chair, Department of Health Administration and Policy, GMU) for that kind introduction. It’s very nice to be here.
You all may not know this, but PJ has been doing research through a HRSA grant to develop models for improving health insurance coverage for the working uninsured in Virginia. Of course, now that health care reform has been passed, her research might change direction a bit. But whatever direction the work takes you, PJ, I’m sure you and your GMU colleagues will continue to bring excellence and yes, quality—to the table.
First and foremost, I would like to recognize all the nurses here who ensure that their patients remain safe and receive high quality care. As a nurse who began her career in the rural plains of North Dakota, I appreciate first-hand the role that nurses and others play in patient safety.
It was barely ten years ago that the Institute of Medicine in a landmark report shattered the widely held perception that American health care was safe. The IOM report, produced by a committee on which I served, not only shook the country out of its complacence, it also recognized for the first time the contributions that clinicians, administrators, organizations, and – yes, the public – could and should be making to improve patient quality and prevent medical errors. It shifted the blame for medical errors from individual caregivers to flaws in the organizational design of the health care system.
It really shook things up.
A decade later, however, there is still a lot of work to be done to improve patient safety and reduce errors. The Medicare Payment Advisory Commission estimates, for example, that unnecessary hospital readmissions cost us as much as $17 billion a year. And every year, we know that thousands of people die as a result of medication errors.
And just a few days ago the Agency for Healthcare Research and Quality issued its two annual reports on quality and health disparities showing that health care associated infections increased and minorities were less likely to get the treatments they needed. As Secretary Kathleen Sebelius commented, the reports demonstrate why passing health reform was so critical. They also underscore once again why a very sharp and focused effort on improving quality of care is so fundamental, as are the types of efforts that are being recognized here this evening.
Of course, the drive isn’t just in reporting the state of the nation on quality measures, it’s also a steady drive to link payments to quality of care. Earlier this week, for example, CMS proposed new policies that would strengthen the relationship between payments and quality of service by expanding the quality measures that hospitals report to receive full market basket updates in fiscal year 2012. CMS wants to increase the number of measures from 46 to 55, adding conditions such as catheter-associated infections, blood incompatibility, or foreign objects retained after surgery. This focus on quality, which you embrace, continues to be strongly embraced by various federal agencies and efforts.
At HRSA, we too are focused on strengthening the dimensions of quality across a number of our programs. We are moving from just being known as an access agency to being known as an agency that focuses on access to high quality care for the populations we serve—a mission similar to those that many of you embrace in your organizations.
A commitment to data collection and analysis of patient outcomes is now at the core of this work. Health centers track patient outcomes and that information informs their thinking about the value of the changes they implement. Each year all of our health center grantees input information on patient demographics, services provided, staffing, clinical indicators, utilization rates, costs and revenues.
For example, health centers have established a core set of clinical performance measures for several key health conditions and age groups served by health centers. These measures – which include childhood immunization rates, entry into prenatal care, and control of hypertension – are aligned with those of national quality measurement organizations, such as the Ambulatory Care Quality Alliance and the National Quality Forum.
Right now we’re deeply engaged in efforts to see that health centers make full use of electronic health records and other health information technology. Because we, of course, view EHRs and HIT are central elements in our multi-layered strategy to improve health outcomes for our patients. As part of this we’re using new technologies to expand data collection and analysis because we know it can point the entire network toward improvements in individual care, in management of resources, and in strategies to improve health at the community level.
In our Maternal and Child Health Bureau, all the states that receive funds from us report annually on their progress toward meeting health targets on 18 National Performance Measures.
When state officials apply for their block grant funds each year, HRSA’s staff meet on site with them and talk to them about their performance on these 18 measures, and, if needed, about ways to improve performance.
In our HIV/AIDS Bureau, quality activity has taken a new turn. In 2006, congressional reauthorization of the Ryan White HIV/AIDS Program made client-level data reporting a requirement for the first time. The challenges of moving from reporting in the aggregate in terms of software and training are substantial, and data security, of course, is a special concern for people living with HIV. But the change is almost complete and already we're starting to see how the client-level data can be used to make real program improvements.
All by the way of saying that we are experiencing some of the same infrastructure challenges related to health IT that many of you are experiencing, and – like you – we’re reaping the rewards in terms of efficiencies and quality improvements.
We are also looking at quality in the context of the health care workforce. Yesterday, for example, we had an all-advisory committee meeting of our Bureau of Health Professions, focusing on creating a strong and capable supply of primary care providers. As I told the committees, building the nation’s supply of primary care providers is one of our greatest challenges as we implement health care reforms, and will require a workforce that knows how to work together with shared standards for inter-professional, team-based care.
The concept of team-based care isn't new, and it certainly has implications for the quality of care patients receive. The challenge is implementation of this concept. For example, there are a host of innovations being used to encourage better communication, coordination, and so on, but there's still a need to build a foundation of teamwork to ensure that those activities are meaningful and successful. There is also the need to work smarter by optimizing the practice of all health professionals.
So at HRSA, through our programs, we’re attempting to engage a health care quality agenda on many fronts, embracing and encouraging innovation that drives quality wherever and whenever we can.
Going forward, I can’t let you go tonight without mentioning health care reform, the Patient Protection and Affordable Care Act—which is the official name of the health insurance reform legislation. Of course, health care reform legislation has implications not just for expanding access to care, but also for quality of health care.
For example, in primary care training, preference is given to training programs that use models of primary care such as the medical home; team management of chronic disease; and inter-professional integrated models of health care that incorporate transitions across health care settings—all of these have implications for quality of care.
This particular focus is important to the health of the nation and also important to HRSA, as we support the delivery of quality primary health care through our health center network, which is now the largest provider of primary health care in the United States, seeing close to 20 million patients.
And of course, also important to quality in HRSA’s and other HHS agency programs is the fact that the administration is investing heavily in health information technology, which will help improve the performance of health care providers and push them to a new level of quality and efficiency.
We know that these issues of access to health IT and of a competent workforce are inextricably linked to the quality of care we can deliver.
HRSA’s priorities are also emphasized in the health care reform bill. I won’t go into the details of the more than 50 different provisions that directly affect HRSA, but suffice it to say that the law is underpinned by a clear understanding that access to high-quality care holds the promise of a healthier nation.
The health care reform legislation contains provisions that will allow us to nearly the double the number of patients that health centers see over the coming five years and provides a very significant boost for the National Health Service Corps. In addition, the legislation includes other continuing investments to increase the number of primary care doctors, nurses and others. But at HRSA, we don’t think just about increasing access but also about expanding access to a high-quality workforce and high-quality care.
At HRSA, we’re thinking about moving our programs in ways that address questions such as: How do we improve efficiency while meeting growing demand? How do we collect, analyze and report data within and across an increasingly complex health care system to improve patient and community health outcomes?
Those of you in this room are also answering these and other difficult questions that come up as you work to strengthen care quality against the backdrop of a system that is staggering under the weight of an aging population, an economic downturn, and many other challenges.
But while facing and adapting to these challenges, you and we all need to continue, of course, to keep a sharp eye on how revamps could enhance or adversely impact health care quality. Those of you in this room clearly have that orientation or you wouldn’t be here this evening.
All of you here have been deeply involved in developing higher quality care and services, patient safety, as well as research and policy support. We at HRSA can learn a lot from your work. So congratulations to all the award recipients—and rest assured that quality is a shared agenda.