2011 Douglas T. Miller Symposium
Dennis Wagner, Acting Director, Office of Clinical Standards and Quality
Centers 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
4
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
The “Three-Part Aim”
Generating Abundance for Patients
Better Health for
the Population
Better Care
for Individuals
Lower Cost
Through
Improvement
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Affordable Care Act
Some 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 Act
Look 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
“A
major, overarching theme in the Affordable Care Act is one of measurement,
transparency, and altering payment to reinforce, not simply volume of services, but
the quality of the effects of those services.
Instead of payment that asks, “How much did you do,” the Affordable Care Act
clearly moves us toward payment that asks, “How well did you do?” and, more
important, “How well did the patient do?”
That idea is at the heart of Value-Based Purchasing. It is not just a CMS idea; it is
one increasingly pervading the agenda of all payers.”
Don Berwick, CMS Administrator, April 4, 2011
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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
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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 – Execution
Your work on organ donation is an
extraordinary national example of what
is possible.
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Concentration of Potential Donors
In Nation’s Largest Hospitals



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
Tremendous Variation in Donation Rates in
300 Largest Hospitals
Conversion Rate Distribution among the Largest 300 Hospitals
9/02-8/03
80
Number of Hospitals
70
60
50
40
30
20
10
0
[0%,10%]
[10%,20%]
[20%,30%]
[30%,40%]
[40%,50%]
[50%,60%]
Conversion Rate
[60%,70%]
[70%,80%]
[80%,90%]
Over 90%
Collaborative Engine
Enroll Participants
Select
Topic
Planning
Group
Prework
Identify
Change
Concepts
P
A
P
D
A
S
LS 1
D
S
LS 2
LS3
Support System
ListServe
Site Visits & Filming
Conference Calls
Rapid Sharing
Data Reporting
Website
Measures of Success
Conversion Rate by Month: 2002-2010
80.0%
Conversion Rate
75.0%
70.0%
Collaborative starts here
65.0%
60.0%
55.0%
50.0%
45.0%
JA
N
0
AU 2
G
M 02
AR
0
O 3
C
T0
M 3
AY
0
D 4
EC
0
JU 4
L0
FE 5
B0
SE 6
P0
AP 6
R
0
N 7
O
V0
JU 7
N
0
JA 8
N
0
AU 9
G
M 09
AR
1
O 0
C
T1
0
40.0%
data source: OPTN
Month/Year
UWHC OPO Performance Rates by Year
OPO Conversion Rate: (Eligible Donors/Eligible Deaths)
OPO Adjusted Conversion Rate: (Eligible Donors + Other Donors/Eligible Deaths + Other Donors)
100
90
82
Conversion Rate (%)
80
70
78
73
60
50
69
52
78
81
78
75
70
67
66
54
86
83
59
88
88
88
84
84
84
71
72
2008
2009
75
62
40
30
OPO Conversion Rate
20
OPO Adjusted Conversion Rate
National Conversion Rate (2010 Jan-Jun)
10
0
2001
2002
2003
2004
2005
2006
2007
2010
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 Wagner
Acting Director, Office of Clinical Standards and Quality
Centers for Medicare and Medicaid Services
Office of Clinical Standards and Quality
7500 Security Blvd., MSC: S3-02-01
Baltimore, MD 21244-1850
Phone Number: 410-786-6841
E-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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