2011 Douglas T. Miller Symposium

Dennis Wagner, Acting Director, Office of Clinical Standards and QualityCenters for Medicare & Medicaid Services

April 29, 2011

Plan for This Segment

• “Gestalt” Overview of CMS, Health Reform and Quality Improvement

• Quality Improvement Lessons from the Organ Donation Breakthrough Collaborative – A Story of Abundance

Questions to Run On

• What is happening with healthcare reform nationally and at CMS?

• What can we learn and apply from the success of the national organ donation quality improvement work?

• What is my advice for CMS?

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CMS is Changing

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CMS Vision

CMS is a major force and a trustworthy partner for the continual

improvement of health and health care for all Americans.

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Operating Values

How we shall work together and with others?• Boundarilessness• Speed and Agility• Unconditional Teamwork• Valuing Innovation• Customer Focus

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Better Health forthe Population

Better Carefor Individuals

Lower CostThrough

Improvement

The “Three-Part Aim”Generating Abundance for Patients

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Affordable Care ActSome Key CMS Accountabilities

• Major, Ongoing Demonstration & Testing Authority & Resources (Center for Innovation)

• Accountable Care Organizations• Value Based Purchasing Programs• Health Insurance Exchanges• Expanded Medicaid Programs• Care Transitions to Reduce Readmissions• Expanded Quality Reporting Programs• Expanded Preventative Services• ….and Much More

What Will the Affordable Care ActLook Like on the Front Lines?

• Increasing measurement of quality, efficiency & value• Public reporting and sharing of data• Reimbursement linked to quality, efficient service delivery,

and cost reduction thru improvement• Increasing integration of delivery systems and coordination

of care across settings• Greater role in addressing public health issues• Greater use of health information technology• Creation of a learning environment in healthcare

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New Tools, New Incentives, New Penalties, New Organizations

What does it all mean?

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Value-Based Purchasing and Linking Payment to Quality

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New Tools, New Incentives, New Disincentives, New Organizations

What does it all mean?

Doing the right things for patients will become easier and doing the wrong things will become more difficult.

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Questions for Quick Reaction and Discussion

• What do you like about what you see in this high level summary?

• What do all of us need to do more of, better, differently?

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The Healthcare Quality/Value Challenge

• U.S. spends more per capita on healthcare than any other country in the world

• Quality is often inferior to that of other nations

• Significant variation in quality and cost by geographic location

• Serious disparities in the quality of health care by race, and socioeconomic status

How do we make quality better?

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How do we make quality better?-- Stages of Personal Accountability --

• Stage 1. “The data are wrong”• Stage 2. “The data are right, but it’s not a problem

”• Stage 3. “The data are right; it is a problem; but it

is not my problem.”• Stage 4. “I accept the burden of improvement”

How do we make quality better?

• Clear Intent – Will• Proven Practices – Ideas• Focused, Constant Action -- Execution

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How do we make quality better?

• Clear Intent – Will• Proven Practices – Ideas• Focused, Constant Action – ExecutionYour work on organ donation is an

extraordinary national example of what is possible.

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50% of eligible donors are found in 206 hospitals

75% of eligible donors are found in 483 hospitals

90% of eligible donors are found in 846 hospitals

Concentration of Potential DonorsConcentration of Potential DonorsIn Nation’s Largest HospitalsIn Nation’s Largest Hospitals

Tremendous Variation in Donation Rates in 300 Largest Hospitals

Conversion Rate Distribution among the Largest 300 Hospitals 9/02-8/03

0

10

20

30

40

50

60

70

80

[0%,10%] [10%,20%] [20%,30%] [30%,40%] [40%,50%] [50%,60%] [60%,70%] [70%,80%] [80%,90%] Over 90%

Conversion Rate

Nu

mb

er o

f H

osp

ital

s

Collaborative Engine

Select Topic

Planning Group

Identify Change

Concepts

Enroll Participants

Prework

LS 1 LS3LS 2

Support System

ListServe Site Visits & Filming

Conference Calls Rapid Sharing

Data Reporting Website

S

A D

P

S

A D

P

Measures of Success

Conversion Rate by Month: 2002-2010

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

JAN02

AUG02

MAR03

OCT0

3

MAY04

DEC04

JUL0

5

FEB06

SEP06

APR07

NOV07

JUN08

JAN09

AUG09

MAR10

OCT1

0

Month/Year

Co

nv

ers

ion

Ra

te Collaborative starts here

data source: OPTN

UWHC OPO Performance Rates by Year

7369

66

7875

78 8184 84 84

8278

8386 88 88 88

52 5459 62

6771 72 75

70

0

10

20

30

40

50

60

70

80

90

100

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Conv

ersi

on R

ate

(%)

OPO Conversion Rate

OPO Adjusted Conversion Rate

National Conversion Rate (2010 Jan-Jun)

OPO Conversion Rate: (Eligible Donors/Eligible Deaths)OPO Adjusted Conversion Rate: (Eligible Donors + Other Donors/Eligible Deaths + Other Donors)

What generated this abundance of life saving results?

Including the Customer: Donor Families and Recipients

Clear, Ambitious, Achievable Aims Transparent About Data and Practice Model for Improvement and Collaborative

Methodology Teaming Nationally to Work Smarter, Faster Creating Bolder, Thoughtful Agendas for Action Rapid Testing & Change Using Proven Practices Doing More Of What Works Relentless Pursuit of Improvement, Never Settling

for the Status Quo

Questions for Discussion and Action

• What are your key insights about the organ donation improvement work?

• How can each of us take this further?

• What can we learn and apply to our current challenges and opportunities with healthcare reform?

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“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” –Margaret Mead

Contact Information

Dennis WagnerActing Director, Office of Clinical Standards and Quality

Centers for Medicare and Medicaid ServicesOffice of Clinical Standards and Quality

7500 Security Blvd., MSC: S3-02-01Baltimore, MD 21244-1850

Phone Number: 410-786-6841E-mail Address: dennis.wagner2@cms.hhs.gov

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Question for Reflection and Action

What is it about this work that makes my heart sing?

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