10. End-stage renal disease quality measures
Last month, the federal government released the first round of payment penalties for dialysis centers with lower scores on quality measures and one in three, or 1,300 of the 5,000 dialysis centers in the country made the list. This is a big deal for all providers
This is huge, because more than a half a million patients in the United States are on dialysis, and the federal government pays the bill for 453,000 who lack private insurance, at an average cost of between $57,639 and $77,506 per patient per year as of 2008. More quality measures will be added to the formula in 2014.
11. Medication management
Making sure that providers who treat patients who need to be on multiple medications for multiple conditions talk to other members of the team to make sure the patients, especially the elderly, are not being prescribed harmful combinations.
A recent report in the New England Journal of Medicine study found that 100,000 seniors a year require costly, emergency hospitalization because of misuse and adverse reactions to of prescription drugs, with four medications responsible for 67%, either alone or in combination.
Additionally, keeping patients compliant with their regimen, communicating with pharmacies, and making sure that patients are on the correct medications when they're discharged from the hospital –– not necessarily the same ones they took before they were admitted – will be an increasing challenge for providers.
12. Waste, fraud, and abuse
In November of 2010, the Office of Inspector General's report found that of nearly one million Medicare beneficiaries discharged from hospitals in just one month – October of 2008 – one in seven experienced an adverse event and nearly half of those were preventable medical errors, substandard care and inadequate patient monitoring and assessment. This is one category of avoidable spending.
Another is the fact that far too many patients are getting unnecessary procedures, including surgery or undergoing care with the use of new "better" technology that really isn't.
In his address at the Institute for Healthcare Improvement forum in Orlando last month, outgoing CMS administrator Don Berwick, MD, called it "overtreatment – the waste that comes from subjecting people to care that cannot possibly help them – care rooted in outmoded habits, supply-driven behaviors, and ignoring science."
What the Patient Centered Outcomes Research Institute, PCORI, does this year when it begins to prioritize its research hospitals projects may make some providers nervous, especially if the results of that research throw doubt on a key line of service or major device acquisition.
That's our list, although undoubtedly there are other worthy candidates we could have included. Can you suggest others? If so, please do so in the comment section below or send me an e-mail. Maybe we'll have enough for a sequel.
Happy New Year.