In the year ahead, the QIO Program will focus on achieving its top objectives: aligning its work with important national health care priorities and continuing to improve the quality of care for Medicare beneficiaries nationwide. Following are some of the pressing health care priorities that Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) will be helping address at the community level in collaboration with partners and other stakeholders.
Current estimates show that over two million people suffer from opioid use disorder, with a prevalence in Medicare of six out of every 1,000 beneficiaries. In 2015, opioids—which include prescription drugs like methadone and illicit substances like heroin—killed more than 33,000 people, the highest number in recorded history. Methadone-related deaths in particular showed an increase in the 65+ -year-old population.
About 25 percent of adults aged 65 years or older have some type of mental health problem, such as a mood disorder not associated with normal aging. Although social ties are one of the strongest predictors of well-being, about
12 percent of adults aged 65 or older report that they “rarely” or “never” receive the social and emotional support they needed. Additionally, excessive alcohol use, including binge drinking, accounts for more than 21,000 deaths among adults 65 or older each year in the United States. Excessive drinking increases a person’s risk of developing high blood pressure, liver disease, certain cancers, heart disease, stroke and many other chronic health problems, as well as a person’s risk of car crashes, falls and violence. Excessive alcohol use can also interact with prescription and over-the-counter medications, and affect compliance with treatment protocols for chronic conditions, thus undermining the effective management of chronic diseases.
The American Hospital Association recently published a report showing that health systems, hospitals and post-acute care providers must comply with 629 mandatory regulatory requirements, and these entities spend nearly
$39 billion a year solely on administrative activities. The report also showed that an average-size hospital dedicates 59 full-time employees to regulatory compliance, over one-quarter of which are doctors and nurses. Additionally, across CMS’s hospital quality reporting programs, inpatient hospitals report up to 61 quality measures, 12 of which are“chart abstracted,” meaning that hospital staff must manually enter the values. Some family practitioners have to report nearly 30 measures to seven different payers, leading to less time focused on patients and contributing to clinician burnout.
Based on preliminary data, hospital inpatients experienced an estimated
3.8 million harm events in 2015, accounting for more than $43 billion in costs and leading to 170,000 deaths. It is estimated that about 44 percent of these events and deaths were preventable.
Just over 1.4 million residents were living in U.S. nursing homes on December 31, 2014, corresponding to 2.6 percent of the over-65 population and
9.5 percent of the over-85 population. A recent fall resulting in injury has been experienced by 5.3 percent of residents, and an additional 11 percent of residents have had a non-injurious fall. Both injurious and non-injurious falls are more common among those with greater cognitive impairment. Pressure ulcers of Stage 2 or greater were present in 5.1 percent of nursing home residents, a 10 percent decline since 2011 (5.9 percent). Physical restraint use has become quite rare, with 1 percent of residents having any restraints in the past seven days. Antipsychotic use, however, is quite common, with more than one out of five residents (21.7 percent) receiving an antipsychotic medication at least once in the past seven days.
Medicare Fee-for-Service beneficiaries experienced 1.7 million readmissions within 30 days in 2015; we estimate that about one million of these readmissions were potentially preventable at a cost to Medicare of nearly
$14 billion. In addition, we project that approximately 15 percent of 9.8 million hospital admissions in 2015 were for potentially preventable conditions.
Each year, over 1.5 million people have a heart attack or stroke; 1.5 million adults develop diabetes; and more than 800,000 die from cardiovascular disease (CVD). Twenty-six percent of Medicare beneficiaries have diabetes, which accounts for 32 percent of Medicare spending. By 2020, an estimated 52 percent of the adult population will have diabetes or pre-diabetes.
Thirty million adults or one in seven have chronic kidney disease (CKD), and 96 percent do not know they have it.
Americans in rural areas have higher rates of cigarette smoking, hypertension, obesity and physical inactivity, which can lead to lower life expectancy. Residents of rural areas have a life expectancy of 76.7 years compared with 79.1 years for residents of metropolitan areas.