Saturday, October 2, 2010

Call for Action

Diane Meier asked us to post this call for action to GeriPal.  Please act!  Cross posted at Pallimed with terrific example feedback to the National Health Care Quality Strategy by Lyle Fettig.

Dear colleagues-

We have an important opportunity to influence the degree to which palliative care and hospice are integrated into our future health care system. There are currently 2 places requesting input from the public:  via the federal government's Department of Health and Human Services (HHS) National Quality Strategy initiative and the National Quality Forum calls for public comment on quality of care. Palliative care is the linchpin for quality among the highest risk highest cost patient populations in the United States and this is an opportunity for us to focus attention to the impact and priority of our work (or, as they say, "be at the table or be on the menu").

Deadline for HHS is October 14, 2010 and deadline for the NQF is October 19, 2010.

1.  The National Health Care Quality Strategy- requires the Secretary of HHS (Secretary Sebelius)  as a provision of the Accountable Care Act (ACA - otherwise known as "the health reform bill"), to establish the framework for health care quality. This scaffolding will be determinative for most of the future work of HHS- demos, pilots, comparative effectiveness research priorities, and many other elements of reform and improvement of our current health care system.

Go here for instructions and the web link for submission.

2. The National Quality Forum's Measure Development and Endorsement agenda is as important as the HHS National Quality Strategy because the Secretary and HHS are required by statute in the ACA to work with a public-private consensus building organization in the identification and implementation of quality measurement - the National Quality Forum (NQF).  As many of you know, NQF's National Priority Partnership included palliative and end of life care as one of its 6 most actionable priorities that if scaled up soon could have substantial and measurable beneficial impact on quality of health care in the United States. 

In July of 2009, the NQF established a measure gap prioritization committee to identify areas of greatest import for measure development-

This is required as a provision of the ACA and a great deal of money, time, and effort is directed at improving quality measurement under the new law. Those areas with highest priority will get the lion's share of the resources and attention in the effort to link care delivery to quality in the next few years.

Unfortunately, there was NO representation from the hospice and palliative care field on NQF's Measure Prioritization Advisory Committee, and among the priorities voted upon (20), palliative care is the only priority that received ZERO votes! (see slide 71 under Advisory Committee Web Meeting Meeting Materials pdf under details)

Votes tallied as follows:

DOMAINS                                           VOTES
Resource use/overuse                              16
Care coordination and management           15
Health status                                           8
Safety processes and outcomes                 8
Patient and family engagement                   7
System infrastructure supports                   5
Population health                                      4
Palliative and end of life care                      0

After several queries, it is clear that it is too late to influence the voting process, but I have been told to encourage as many public comments as possible about this oversight and its implications for our nation's ability to improve quality for patients and populations and to get a handle on health care spending (Don Berwick's "Triple Aim"- better care/affordable care/healthy people, healthy communities).   Palliative care addresses all three goals, and is especially important for improving the experience of care received by patients and families.

To follow directions for public and member comment (CAPC, NHPCO, AAHPM, HPNA, NPCRC are all NQF members) click here to register quickly and leave a comment.

During my policy fellowship I have been increasingly impressed by how seriously public comments are taken; how carefully they are read and discussed; and the obligation that executive branch and NQF staff feel to incorporate them into the final report, rule or regulation before it is released.  Both the actual number of comments, and their consistency or level of consensus among stakeholders are considered.  Therefore I encourage individual health palliative and hospice care professionals, membership organizations, and the Hospice and Palliative Care Coalition to send comments to both entities before the deadline of October 15 for HHS and October 19 for NQF.

Please do not hesitate to contact me if I can be of any help with this process.  I know how ridiculously busy everyone is and I would not ask for your attention to this matter if I was not convinced of its importance by my colleagues at HHS and the NQF. Thanks all.

by: Diane Meier

4 comments:

Anonymous said...

Resource use/overuse, care coordination & management, health status, patient & family engagement - if NQF developed reliable measures of these, would go a long way to measuring palliative & end of life care.

Specific Canadian quality indicators for hospice palliative care are essentially these.

Paul McIntyre

Christian Sinclair, MD said...

Thanks for posting this Alex. We are working on a blog post right now over at Pallimed on the same topic. WE need to figure out a way to rally people behind this and make it easy to participate. I was brainstorming with Lyle Fettig about posting our responses all online where we could see them and take the best of what we were seeing and put it in our own voice.

Sometimes policy can be overwhelming but when you pay attention it counts.

Anonymous said...

Can you publish the entire link for the NQF's directions for member comment? I hit "click here" but the link wasn't live.

Alex Smith said...

Thanks Anon for pointing out the falutly link for NQF. I fixed it. Click the word "here" above again to register to leave a comment. Please share your experience online! I agree with Christian and Lyle that it's a good idea to share our feedback. We should dessiminate great talking points.