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  • Center for Healthcare Quality and Payment Reform
    might like and C Sections often are used to shorten labor or to make babies adapt to the busy schedules that their mothers and doctors have Yet that temporary convenience can harm both babies and mothers sometimes permanently C Sections are particularly problematic when they re used to deliver babies too early The desire for convenience has resulted in a growing number of cases where doctors use drugs or procedures to induce labor rather than let the pregnancy take its natural course About one fourth of deliveries are now electively induced before the baby has reached full term 39 weeks Yet research has shown that even babies born a few days too early are more likely to have problems such as developmental delays Moreover labor inductions before 39 weeks are more likely to result in expensive and risky C Sections and the baby is more likely to spend time in an expensive neonatal intensive care unit NICU These unfortunate trends can be reversed For example a team of physicians and nurses at Pittsburgh s Magee Womens Hospital using Perfecting Patient Care training they received from the Pittsburgh Regional Health Initiative reduced the rate of early elective inductions by 64 and reduced the frequency of C Sections in elective inductions by 60 They won the Fine Award from the Jewish Healthcare Foundation in recognition of their cutting edge work There are additional opportunities for even greater savings in maternity care For example Birth centers are a safe option for healthy women with normal pregnancies who would rather deliver babies outside of a hospital setting and they typically cost one fourth as much as a hospital delivery Fewer pregnancy complications and better birth outcomes could be achieved if more women received early and adequate prenatal care Unfortunately one in every five mothers

    Original URL path: http://www.chqpr.org/maternitycare.html (2016-04-30)
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  • Center for Healthcare Quality and Payment Reform
    tools are not merely static guidelines they are also data collection tools The choices physicians make using the tools and the outcomes their patients achieve will be recorded and used in two important ways Individual physicians will receive feedback on their own ordering patterns For example if a physician had a high rate of ordering stress tests for patients where those tests may be appropriate the physician would be able to see whether other physicians were achieving similar or better results for similar patients by using fewer tests or less risky and invasive tests The appropriate use criteria will be improved Through SMARTCare the teams of physicians who develop and maintain the appropriate use criteria would have more detailed data available to use for refining the criteria and providing clearer guidance as to which tests and procedures are likely appropriate or inappropriate in more unusual cases The data collected will be added to the PINNACLE registry and the NCDR registry to support research about outcomes and the refinement of existing criteria SMARTCare physicians would collect and report on a series of quality and performance metrics to assure patients and payers that patients were receiving truly better care and achieving better outcomes at lower cost This would include measures of patient experience as well as clinical quality measures Costs and Savings Expected from SMARTCare Fewer Unnecessary Tests and Procedures Today due to misinformation about the nature of heart disease and about the benefits of different tests and treatments many patients end up receiving unnecessary testing unnecessarily expensive or invasive testing and unnecessarily expensive and risky interventions SMARTCare is designed to ensure that patients who really need tests and interventions receive the most appropriate ones while sparing the others the risks and costs associated with unnecessary tests and treatments SMARTCare is expected to reduce spending in the following ways Reducing unnecessary use of stress tests Currently about 15 20 of non invasive imaging tests do not meet appropriate use criteria and SMARTCare could enable this to be reduced to less than 8 Reducing unnecessary use of the most expensive and risky forms of stress tests such as nuclear imaging Reducing unnecessary use of invasive imaging i e angiograms Reducing unnecessary use of percutaneous coronary interventions stents Currently 9 20 of stent procedures do not meet appropriate use criteria and SMARTCare could reduce this to less than 6 While savings from fewer tests and procedures will be significant it is important to recognize that the true savings will be less than the current amount that payers are paying for the avoided tests and procedures There are fixed costs associated with a cardiology practice a cardiac testing facility and a cardiac catheterization laboratory which must still be covered even if fewer tests and procedures are performed Consequently changes in the payment system will be needed to allow cardiology practices and hospitals to reduce unnecessary spending without jeopardizing their ability to continue providing the appropriate tests and procedures to the smaller number of patients who

    Original URL path: http://www.chqpr.org/cardiac-care.html (2016-04-30)
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  • Center for Healthcare Quality and Payment Reform
    ACOs Reform Opportunities Cancer Care Readmissions Maternity Care Cardiac Care Other About Us Mission Staff Home Reform Opportunities Other Opportunities Other Opportunities Coming Soon 2008 2011 Center for Healthcare Quality and Payment Reform All rights reserved 320 Ft Duquesne Blvd

    Original URL path: http://www.chqpr.org/otheropps.html (2016-04-30)
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  • Center for Healthcare Quality and Payment Reform
    known as ambulatory sensitive conditions such as asthma chronic obstructive pulmonary disease congestive heart failure diabetes etc In addition a high proportion of people who are hospitalized are readmitted within 30 days frequently for the same condition that they were admitted for or for a complication or infection resulting from that initial admission Again payers pay more when these admissions and readmissions occur and patients suffer from them And again reducing admissions and readmissions represents a win win for both quality and cost The problematic incentives in current healthcare payment systems are increasingly recognized as one of the major barriers to addressing these kinds of problems Under current payment systems physicians hospitals and other healthcare providers gain increased revenues and profits by delivering more services to more people which in turn fuels inflation in healthcare costs Research has shown that more services and higher spending do not result in better outcomes indeed it is often exactly the opposite But what is even more troubling is that current payment systems often financially penalize healthcare providers for providing better quality services Providers frequently lose revenues and profits if they keep people healthy reduce errors and complications and avoid unnecessary care This not only leads to many of the problems in healthcare quality which exist today but impedes efforts to improve quality by forcing a tradeoff between a healthcare provider s financial well being and the quality of their services Although not all quality and cost problems are caused by payment systems and not all quality and cost problems can be resolved by changes in payment systems it is clear that in many cases payment reform is at least a necessary element of efforts to increase the value provided by the nation s health care system Fortunately many people now believe that there are better ways to pay for health care ways that give healthcare providers more responsibility for increasing quality and controlling costs of services without penalizing them financially for treating sicker patients Systems called episode of care payment involve paying a single price a case rate for all of the services needed by a patient for major acute episodes such as a heart attack or a hip replacement regardless of which providers are involved instead of multiple fees for each specific service provided Systems called risk adjusted global fees and condition specific capitation go a step further and pay healthcare providers a single fee for all of the outpatient care needed by their patients particularly those with chronic diseases in ways that reward the providers for keeping their patients healthy and for reducing duplicative and unnecessary healthcare services Implementing these kinds of improvements in payment systems holds significant promise for improving the quality and reducing the cost of health care But there are a number of important issues that need to be addressed and a variety of challenges which need to be overcome in order to move them from concept to reality In particular Which health care providers if any are

    Original URL path: http://www.chqpr.org/goals.html (2016-04-30)
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  • Center for Healthcare Quality and Payment Reform
    2008 CHQPR has become a nationally recognized source of unbiased information and assistance on payment and delivery reform CHQPR s publications are among the most widely used and highly regarded resources on payment reform and accountable care in the country CHQPR has provided information and technical assistance to Congress to federal agencies such as CMS and MedPAC to national organizations such as the American Medical Association and the American Hospital

    Original URL path: http://www.chqpr.org/about.html (2016-04-30)
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  • Center for Healthcare Quality and Payment Reform
    for Cancer Care How Healthcare Payment Systems and Benefit Designs Can Support More Accurate Diagnosis and The Payment Reform Glossary the Network for Regional Healthcare Improvement s reports Making the Business Case for Payment and Delivery Reform and The Building Blocks of Successful Payment Reform the Massachusetts Hospital Association s report Creating Accountable Care Organizations in Massachusetts the American Medical Association s report Pathways for Physician Success Under Healthcare Payment and Delivery Reforms the Medical Society of Virginia s report How Virginia Physicians Can Improve the Quality and Reduce the Costs of Health Care Through Payment and Delivery Reforms and the Association of Departments of Family Medicine s report Leading the Way in Accountable Care How Departments of Family Medicine Can Help Create a Higher Quality More Affordable Healthcare System He assisted the American Society of Clinical Oncology in developing Patient Centered Oncology Payment a new payment model designed to support better care for cancer patients at lower cost From 2008 to 2013 Miller served as the President and CEO of the Network for Regional Healthcare Improvement NRHI the national association of Regional Health Improvement Collaboratives and he organized NRHI s national Summits on Healthcare Payment Reform in 2007 and 2008 and its Summit on Regional Healthcare Transformation in 2013 His report Creating Payment Systems to Accelerate Value Driven Health Care Issues and Options for Policy Reform which was prepared for the 2007 Summit was published by the Commonwealth Fund in September 2007 and his summary of the recommendations from the 2008 Payment Reform Summit From Volume to Value Transforming Healthcare Payment and Delivery Systems to Improve Quality and Reduce Costs was published in November 2008 by NRHI and the Robert Wood Johnson Foundation From 2006 to 2010 Miller served as the Strategic Initiatives Consultant to the Pittsburgh Regional Health

    Original URL path: http://www.chqpr.org/staff.html (2016-04-30)
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