2011 QualityNet Conference
December 14, 2011
Thank you for that kind introduction. I am delighted to be here. Before I begin there are a few people I want to recognize…
I want to thank Dr. Patrick Conway for his terrific work as Chief Medical Officer at CMS and his service Medicare and Medicaid’s millions of beneficiaries.
Dr. Rick Gilfillan who has led CMS’s Innovation Center as it opened its doors and is already beginning to shape the national conversation about quality in health care.
And I want to thank everyone else from CMS for making this conference possible, but more importantly for your commitment to improving care for all Americans.
I also want to acknowledge Don Berwick, who is not here today, but who may be more responsible than anyone for our Department’s increased focus on quality.
Unfortunately, the Senate only gave him to us for 18 months. But he achieved more in that short time than some people do in that role with 4 years. And I know we will continue to see the impact of his work for years to come.
We are lucky to have Marilyn Tavenner leading the agency today. Not only has she worked hand-in-hand with Don over the last year and a half, but she brings one of the most unique skill sets of anyone who has ever taken the job. Marilyn has great experience as a manager, but she also has a keen understanding of care at the patient level. I know she will leave her own mark on this agency and the people we serve.
I came to HHS as a Governor where I ran our state’s Medicaid and CHIP programs. And I was also responsible for buying private insurance for all of the public employees in my State.
I saw what happens when our system ignores the quality of the care it provides.
I saw patients harmed, or worse, by unnecessary treatments, medical errors and hospital acquired conditions. I saw providers so disillusioned that they contemplated leaving health care altogether. And I saw skyrocketing costs place an enormous burden on family, state and federal budgets – and put American businesses at a serious disadvantage in a global economy.
We have to do better: better health, better care, lower costs. The reason we have all come together, here as part of the largest gathering of health care quality leaders ever assembled by the Federal government, is because we recognize that, in order to do these things better, we are going to have to do them together.
Now, for the most part, we already know where we should be going -- toward a high-performing, patient-centered health care system built on the latest evidence, the most advanced technology, and a focus on keeping people healthy. It’s about getting the right care to the right person at the right time -- each and every time.
But as you know, that goal has been elusive. The United States leads the world in developing new approaches and new technology to prevent, diagnose, manage, and cure illness. Our academic institutions educate and train the best physicians and nurses. And yet, while these advances have dramatically improved care for millions of people, they do not reach everyone who needs them.
Too many patients have been harmed by a health care system that’s supposed to help them get well and stay healthy. And too many doctors and nurses have seen their best intentions frustrated by backward incentives in a fragmented system.
Many of us have been working to address these challenges for years. I met Don Berwick for the first time in the mid-90s when I was Kansas Insurance Commissioner and we both served on President Clinton’s Commission on Health Care Quality.
We have made real progress since then. Twenty years ago we had an understanding about the importance of helping doctors work more closely together, of aligning incentives for health care providers, and collecting and analyzing better data on health outcomes. But we didn’t have many models or tools to make those changes possible.
Today, those models exist. I have seen them all over the country putting new approaches to patient safety and care to work every day.
The Iowa Healthcare Collaborative, which includes 117 hospitals across the state, cut MRSA bloodstream infections in half in just two years.
Ascension Health System’s more than 70 hospitals have demonstrated a 53 percent reduction in Ventilator Associated Pneumonia and a 30 percent reduction in birth trauma since 2007.
And the Pennsylvania Quality Improvement Organization has built a partnership with its Area Agency on Aging that has helped a group of 5 hospitals in Western Pennsylvania reduce readmissions of Medicare fee-for-service patients by 14 percent.
These are just a few examples. I know there are many more institutions getting results, setting the bar higher and higher every day. I know many of you are here today and I want to thank you all for your leadership.
Please keep the drumbeat going in your own communities by continuing to spotlight the success of your partners and colleagues. One important way to help excellence spread quicker and further is by holding it up for everyone to see, study, and adapt.
Another problem we faced in the mid-‘90s was that, even when we did have a model of quality care, some people doubted that it was possible to bring these results to scale.
They wondered whether providing high-quality care was like playing in the NBA, limited only to a select few with exceptional natural ability. But what we’ve found is that it’s more like shooting a free throw. Anyone can do it if they are committed and get the right support.
The reason we know this is possible is because today these pockets of excellence are already beginning to spread.
A great example is central line infections in intensive care units. As you know, researchers first developed a checklist that significantly reduced the occurrence of these infections. Then that checklist was taken to Michigan, where they saved 1,500 lives and reduced health care costs by $200 million in just 18 months.
And today, with the support of our Department, these best practices are spreading across the country. Between 2001 and 2009, ICU central line infections fell 63 percent nationally.
That’s an incredible accomplishment. Because of this effort, thousands of Americans are still living happy lives, going to work, seeing their grandchildren. Everyone who played a part should be incredibly proud.
But think for a second just how limited an achievement like this is.
This wasn’t all healthcare-associated infections; it was infections associated with one procedure. It was not even all central line infections; it was just those in ICUs. And it was not a 100 percent reduction or even an 80 percent reduction. It was a 60 percent reduction. That is a real achievement, but it also a sign that we have room to go even further.
The truth is that despite the successes we see around the country, injuries from care are still far too prevalent.
So, as we look back I think we can say two things: we have made some progress, and it is not nearly enough. Let me put it in even stronger terms: if we only improve care as much in the next two decades as we have in the last two, we will have failed.
The good news is that we now have a law that makes this moment a very exciting time to be involved in improving health care.
There are really two parts to the Affordable Care Act.
Over the last year and a half, a lot of attention has been paid to the first part, which includes important new consumer benefits and coverage. But the second part is just as important: that is where we are making a powerful investment to transform the delivery of care, with dozens of tools to help providers provide care more effectively and affordably.
For example, we’ve launched an initiative that ties payments to quality for 3,500 hospitals across the country and nearly 5,000 ESRD facilities beginning next year. Over time, even more money will be paid out on the basis of quality, creating powerful incentives for improvement.
And we’ve provided guidance to help doctors and hospitals form Accountable Care Organizations where they share the savings if they keep their patients healthy.
We’re also taking steps to unleash the power of constant experimentation. In the ‘90s when we looked at how the government could advance innovation in health care quality, what we encountered was bureaucracy moving at a glacial pace.
It took at least a year to get Congress to fund a demonstration project; another year to develop the demonstration; two or three years to conduct the demonstration, and another year to evaluate it. Then we had to go back to Congress in order to make it policy. By then our innovative idea wasn’t so new anymore.
Today, thanks to the Affordable Care Act, we have a first-of-its-kind CMS Innovation Center with the flexibility to test new models for delivering higher-quality, lower-cost care. Not every new approach is going to succeed. But what is important, is that when models do work, we have the authority and the resources to make them into policy.
And it’s not just going to be CMS. These reforms will have an even bigger impact when they are adopted and supplemented by other payers, creating powerful incentives for improving care across the health care system.
That’s the idea at the heart of the Partnership for Patients which I know you have already discussed. But I want to reiterate what I see as the Partnership’s most powerful message: that it is possible to unite a nationwide alliance behind a common set of goals. In this case: reducing preventable injuries in hospitals by 40 percent, and cutting hospital readmissions by 20 percent.
We weren’t sure what kind of response we would get when we launched the Partnership 8 months ago. It is voluntary program and no one is forced to sign-on. But the response has been enormous, which I think says a lot about how deeply people appreciate the benefits of collaboration.
We've never seen this many high-level partners join together to promote patient safety: Clinicians, consumers, employers, quality improvement organizations, dialysis facilities, and more than 3000 hospitals.
When you suddenly have everyone on the same team, they can stop looking for slow incremental change and start building a culture of rapid innovation and continuous improvement.
And today I’m proud to announce that the CMS Innovation Center is awarding over $200 million to 26 state, regional and national hospital system organizations to serve as Hospital Engagement Networks in support of the Partnership for Patients.
I would like to ask these groups to please stand now so that we can recognize you -- but more importantly so that we can reach out to you, today and in the weeks ahead, to begin building the partnerships so essential to our future success.
We recognize that raising the quality of care across the country requires more than simply taking what works in rural Colorado and plugging it into urban Los Angeles. It means giving people the skills and the tools to adapt best practices to their own environments and institutions.
Hospital Engagement Networks will provide those tools and resources so that providers everywhere can meet the Partnership’s goals.
But more specifically, they will continue to nurture a culture learning and collaboration that has been at the heart of the Quality Improvement Organization Program from the start.
That’s why 16 of the 26 Hospital Engagement Contractors we’re announcing today – have already built partnerships with Quality Improvement Organizations into their plans. And we expect that the others will also work together formally and informally over the next few years.
The Partnership for Patients is also an important test of how the nation can act as one to address a major national challenge.
The last and most important reason we do this work is because people know what the alternative is. Health care costs cannot keep rising at this rate, and if we don’t improve care we’re going to have to cut it.
Recently we’ve seen some proposals in Congress to do just that. Their initial cuts might start only with patients, but eventually they will reach further and touch everyone who is a part of our health care system.
We are all here today because we believe the better choice is to lower costs by improving care. To do that we all have a role to play. My pledge to you is that we will continue to be active partners in improving health care.
The National Quality Strategy charts a path forward and the Affordable Care Act provides the resources and incentives to get moving.
History has taught us that, when we see a glimmer of light at the end of the tunnel, we need to push down on the accelerator, not ease up. So I want to ask you to look beyond the hospital or clinic where you are making an impact today. And imagine how you can work together to share what you’re doing even wider and even quicker.
Each of us has the power to bring about rapid, widespread improvement in the way health care is delivered. Because each of us is part of a bigger movement. Together we can make sure no one in this country is deprived of the quality care, we know exactly how to provide.