CMS Extends Funding for Hospital Engagement Networks
On September 25, 2015, the Centers for Medicare & Medicaid Services (CMS) awarded $110 million to 17 national, regional, or state hospital associations and health system organizations to fund a second round of Hospital Engagement Networks (HEN), which will extend through September 2016. The contracts are part of the Partnership for Patients, a nationwide public-private collaboration designed to protect patients from being harmed while in the hospital and suffering complications after discharge.
Launched in April 2011, the Partnership for Patients strives to engage short-stay acute care hospitals across the nation in improving the quality of care delivered to patients. Along with the HENs, partnerships with physician, nursing, and pharmacy organizations, consumers and consumer groups, and employers have emerged to align their efforts. In addition, private health plans, local agencies on aging, and state and federal government officials have pledged to work together to meet the initiative’s goals.
The Partnership for Patients and the HENs operate within a framework established by the Affordable Care Act to deliver better care to individuals and the population, and to spend dollars more wisely. The Department of Health and Human Services has estimated that 50,000 fewer patients died in hospitals and that approximately $12 billion in healthcare costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. Nationally, in that same time period, patient safety has improved, resulting in 1.3 million adverse events and infections avoided in hospitals. This translates to a 17% decline in hospital-acquired conditions during that time frame. In addition, 30-day hospital readmissions in Medicare decreased by nearly 8% between January 2012 and December 2013—translating to 150,000 fewer readmissions.
Partnership for Patients
The focus of the Partnership for Patients’ work going forward will be to sustain national progress on its existing goals:
- Keep patients from getting injured or sicker. Decrease preventable hospital-acquired conditions by 40% compared to 2010.
- Help patients heal without complication. Decrease preventable complications during a transition from one care setting to another so that 30-day hospital readmissions are reduced by 20%compared to 2010.
Concurrently, the Partnership will conduct evaluations to more assess its contribution to national improvements in patient safety.
Hospital Engagement Networks
The HENs will continue to identify solutions that already succeed at reducing healthcare-acquired conditions, and work to spread them to other hospitals and healthcare providers.
HENs work at the national, regional, state, or hospital system level to develop learning collaboratives for hospitals so that they can implement the changes and innovations necessary to achieve the Partnership for Patients’ safety and care-transition goals. HENs engage in a wide array of initiatives and activities to spread established, evidence-based interventions to rapidly improve patient safety in hospitals.
The Partnership for Patients will continue to evaluate the capacity of large improvement networks to bring about improvement in patient safety. HENs are required to focus on the following 10 core areas of harm:
- Adverse drug events.
- Catheter-associated urinary tract infections in all hospital settings, including avoiding placement of catheters, both in the emergency room and in the hospital.
- Central line–associated bloodstream infections in all hospital settings, not just intensive care units.
- Injuries from falls and immobility.
- Obstetrical adverse events, including early elective delivery reduction. Obstetrical adverse events are to include, at a minimum, obstetrical hemorrhage, and preeclampsia treatment and management to prevent morbidity and mortality.
- Pressure ulcers.
- Surgical site infections (SSI), including measurement and improvement of SSI for multiple classes of surgeries.
- Venous thromboembolism, including, at a minimum, all surgical settings.
- Ventilator-associated events, including infection-related ventilator-associated complications and ventilator-associated conditions.
- Readmissions.
In addition to these topics, HENs are expected to address all other forms of preventable patient harm in pursuit of safety. HENs are expected to detail their plans to address these other forms of harm, including at a minimum the aims, measures, and evidence-based best practices they propose to put in place. The Partnership for Patients recognizes that the pediatric population has unique needs related to these other forms of preventable harm. Therefore, HENs supporting pediatric hospitals and pediatric wards within general hospitals may choose to augment and delineate an alternative program of work to address highest-risk harms specific to the pediatric population, including readmissions.
Additionally, the following are some topics HENs may consider in addressing other harms:
- Severe sepsis and septic shock
- Hospital culture of safety that fully integrates patient safety with worker safety
- Iatrogenic delirium
- Clostridium difficile, including antibiotic stewardship
- Undue exposure to radiation
- Airway safety
- Failure to rescue
Data Tracking and Reporting
Each HEN, in consultation with the Partnership for Patients, will identify and use appropriate process and outcome measures for each area of focus to track hospital progress on quality improvement. A new requirement in this second round of HENs will mandate that they submit data on a standard list of measures. HENs will also be strongly encouraged to use any additional measures that align with existing measurement activity already underway within their community, or that they feel would be most impactful to the populations they serve.
The HENs will also submit monthly reports to CMS describing their activities and the progress of their quality improvement efforts, including hospital progress on improvement measures for each core area. HENs will submit final reports to CMS at the conclusion of the 12-month period of performance detailing the successes, failures, lessons learned, and areas of improvement in each focus area.
To support hospital submission of measurement data, the HENs will be required to establish a secure, Web-based data collection and management portal. Through this portal, the HENs will have access to hospitals’ measurement data, and will use that information to evaluate progress and focus attention on efforts or hospitals that have yet to see improvement. Data collected by the Partnership for Patients will not be used to evaluate hospital performance for existing quality programs such as the Hospital Value-Based Purchasing Program and the Hospital Readmissions Reduction Program.
The HENs will support approximately 3,400 hospitals during this upcoming 12-month period of performance. The competitive procurement process enabled support for a diverse group of acute care hospitals across the nation in an effort to recruit the active participation of as many of the short-stay acute care hospitals in the country as possible.
Selected Hospital Engagement Network Organizations
The 17 HENs (listed in alphabetical order) for round two are:
- American Hospital Association
- Ascension Health
- Carolinas HealthCare System
- Dignity Health
- Healthcare Association of New York State
- Health Research and Educational Trust of New Jersey
- Hospital & Healthsystem Association of Pennsylvania
- Iowa Healthcare Collaborative
- LifePoint Health
- Michigan Health & Hospital Association Health Foundation
- Minnesota Hospital Association
- Ohio Children’s Hospital Solutions for Patient Safety
- Ohio Hospital Association
- Premier, Inc.
- Tennessee Hospital Association
- VHA-UHC Alliance NewCo Inc.
- Washington State Hospital Association