Improving the quality of care for Medicare beneficiaries is one of our primary objectives. The CMS's GPRA goals reflect quality priorities both in prevention and adhering to quality standards and support the Department's strategic plan goals. Several of the QIOs' national quality priorities are reflected in our performance goals. These health conditions represent those that impact a large number of our beneficiaries and impose a significant burden on the health care system. For example, an estimated 780,000 surgeries are complicated by infection each year resulting in longer hospital stays, increased morbidity, mortality, and health care costs. Therefore, our new goal to prevent surgical site infections focuses on administering antibiotics in a timely manner before a surgical procedure. Sec FY 03 Final QUALITY IMPROVEMENT ORGANIZATIONS Heart Attack Survival - The ambitious goal to increase the 1-year survival rate among beneficiaries who suffer a heart attack illustrates CMS's partnerships with the QIOS to help improve the quality of care for our beneficiaries. This nationwide effort focuses on implementing known successful interventions for properly treating heart attacks and preventing second heart attacks. The impact of these improvements may be especially dramatic in areas where providers have not fully introduced these lifesaving measures. We did not meet our FY 2000 goal to decrease the one-year mortality rate to 27.4 percent among Medicare beneficiaries following hospital admissions for heart attack. In fact, the one-year mortality rate for heart attacks that occurred between August 1, 1999 and July 31, 2000 was 33.2 percent (an increase over the rate for the previous year of 32.3 percent). Based on this data and other recent trends, we do not expect to meet the FYs 2001 and 2002 targets. There are a number of interventions that have been proven to be successful for increasing heart attack survival following a heart attack, and we have made use of these interventions in hospitals. However, recent data indicate that the number of deaths occurring within one year following hospitalization for heart attack is not decreasing. Many complex variables might have made significant independent contributions to the survival rate. We will continue to report our results through FY 2002 but we are discontinuing this goal beginning in FY 2003. The CMS will continue to encourage and monitor research in this area to determine what may be causing these disappointing trends. Adult Immunizations - Our performance goals on adult immunizations (annual influenza and lifetime pneumococcal) are examples of CMS's promotion of preventive health. Complications arising from pneumococcal disease and influenza kill more than 30,000 people a year in the United States -- typically resulting in more deaths per year than for all other vaccine-preventable diseases combined. For all persons age 65 or older. the Advisory Committee on Immunization Practices (ACIP) and other leading authorities recommend lifetime vaccination for pneumococcal pneumonia and annual vaccination for influenza. In recent years, there have been flu vaccine shortages and distribution delays, which have impacted the delivery of immunizations. The inability to quantify the impact of these shortages to date reduces the confidence we have in achieving our targets for the affected years, and for reliably setting future targets. Also, data analyses from different sources point to an apparent leveling off of flu vaccination rates, and most recent data for pneumococcal vaccinations indicate that these rates are slowing down as well. In FY 2001, 67.4 percent of all Medicare beneficiaries age 65 years and older reported receipt of an annual flu vaccine, and 63.3 percent reported receipt of a pneumococcal vaccine in their lifetime. While we exceeded our target to achieve a 63 percent lifetime pneumococcal vaccination rate, we did not meet our target to achieve an annual flu vaccination rate of 72 percent. This decrease in the influenza vaccine rate reflects the QUALITY IMPROVEMENT ORGANIZATIONS temporary shortage and distribution delays that affected the vaccine distribution in 2000 and 2001, which were beyond our control. The CMS and the CDC are still actively addressing the unknown impact of the 2000 and 2001 flu vaccine shortages and delayed delivery on our adult immunization performance measures and are closely monitoring recent trends, especially given the growing number of challenges we face in achieving this goal. Our targets for FYs 2002 – 2004 have been set based on the recent trends. In light of recent trends for pneumococcal, we are revising our FY 2003 target to a more realistic target of achieving a 67 percent lifetime pneumococcal vaccination rate in Medicare beneficiaries age 65 years and older. The CMS will continue to promote the receipt of annual influenza and lifetime pneumococcal vaccinations. We hope that the recent establishment of standing orders for flu and pneumococcal vaccinations in nursing homes, hospitals, and home health agencies will help to overcome some of the barriers that prevent patients from being immunized. Mammography - The CMS's performance goal to increase the percentage of women Medicare beneficiaries age 65 and older who receive a mammogram is another illustration of our Agency's promotion of secondary prevention and increasing cancer survival through early detection. Performance measurement of mammography rates has served to focus resources within CMS for ongoing monitoring and improved performance. Final 2000 NHIS data show that we surpassed our FY 2000 target of 60 percent of women age 65 and older to receive a biennial mammogram by reaching 68.1 percent (the FY 2000 target was measured using NHIS data). We are also pleased to report that we have surpassed our FY 2001 target of 51 percent of women age 65 years and older to receive a mammogram by reaching 51.6 percent. FY 2001 marks the first year CMS used Medicare claims data (National Claims History File) to measure this goal. The CMS's FY 2001 and FY 2002 mammography targets are based on the 1999 Health Plan Employer Data Information Set (HEDIS®) measure for breast cancer screening. Recently, the National Committee for Quality Assurance (NCQA) revised their technical specifications for the breast cancer screening measure and reported the updated definition in the HEDISR 2002 Technical Specifications. The revised indicator reflects changes in billing codes for digital mammograms, conversion of film to digital images, and for computer-aided screening. The CMS's revised mammography indicator is a more restrictive definition than is the current indicator. Reanalysis of biennial 2000-01 mammography data with this “HEDIS® 2002" mammography measure suggest a decrease of 0.6 percent of eligible female beneficiaries age 65 years or older with mammography services paid by Medicare. Consequently, future targets for CMS's mammography goal have been revised, beginning with FY 2003, to account for the more conservative estimates from the HEDIS® 2002 QUALITY IMPROVEMENT ORGANIZATIONS measure. Additionally, trends indicate diminished gains in the biennial mammography rate among women age 65 and older from 1997-98 to 2000-01. In late 2001-early 2002, there was a great deal of controversy in the press regarding mammography, along with press releases from governmental agencies affirming the recommendations for regular mammography screening. For example, the US Preventive Services Task Force (USPSTF) and the National Cancer Institute (NCI) continue to recommend mammography for early detection. Additionally, the Department of Health and Human Services issued a press release affirming the need for mammography screening. Continued outreach and education may be especially important at this time to ensure that women with Medicare get screening mammograms on a regular basis. The CMS remains committed to its mammography efforts. Diabetic Eye Exams - Diabetes is another highly prevalent condition in the Medicare population. Many complications of the discase, such as blindness, can be prevented or delayed with appropriate monitoring and treatment. The CMS's quality goal to increase special eye exams for our diabetic beneficiaries reflects our commitment to improve diabetes care. We surpassed our FY 2001 goal to increase the rate of biennial diabetic eye exams to 68.3 percent by increasing the rate to 68.9 percent. Based on the progress we have seen thus far, we anticipate continued success with this goal. Surgical Site Infections - Optimizing the timing of antibiotic administration has been demonstrated to decrease the incidence of surgical site infection. The addition of this goal in our performance plan is another example of our commitment to preventive health and increasing healthy outcomes for our beneficiaries. The Medicare Surgical Site Infection Prevention Project (SIP) is currently being implemented in 19 States and will be expanded nationally by February 1, 2003. While the SIP Project focuses on the five highest volume surgeries, CMS will only be targeting the total percentage increase in frequency from all the cases followed. Baseline data from 2001 demonstrated that antibiotics were only administered within the recommended timeframe in less than half (47.4 percent) the cases. With national expansion and continued QIO commitment our targets for FY 2003 and FY 2004 increase to 49.8 percent and 54.8 percent respectively, significantly reducing the number of complications our beneficiaries will experience. The 1995-96 national baseline 1-year mortality rate among Medicare beneficiaries hospitalized Discussion: Improving treatment for heart attack has been a focus of CMS's Health Care Quality Improvement Program (HCQIP) since its inception in 1992. The CMS has been working to improve survival (by working to reduce deaths) from heart attack by assisting hospitals to improve their adherence to the following consensus-based treatment guidelines: Aspirin administered early in the hospital course (decreases clotting of the blood); Beta Blocker administered early in the hospital course (decreases heart's workload and oxygen need); Timely initiation of therapy to try to open blocked arteries in the heart (reperfusion therapy); Smoking cessation counseling during hospitalization; Aspirin prescribed at discharge; Beta Blocker prescribed at discharge; and Angiotensin Converting Enzyme (ACE) Inhibitor prescribed at discharge (reduces blood pressure) if the heart's pump function is impaired. During the 1995-96 baseline period (August 1995 to July 1996) approximately 31.2 percent of Medicare beneficiaries hospitalized for heart attack died within a year. Since many patients were appropriate candidates for all or some of the treatments listed above, CMS anticipated that patient survival following a heart attack could be improved |