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Medical Economics: Steinberg’s practice is textbook example of patient-centered medical home

Journal features Commonwealth Medicine physician leader

By Jennifer Rosinski

UMass Medical School Communications

June 05, 2014

The care coordination of an AIDS patient and his HIV-positive wife managed by UMass Medical School’s Judith Steinberg, MD, MPH, is a textbook example of success using the patient-centered medical home (PCMH) model, according to a cover story in the most recent issue of Medical Economics.

Dr. Steinberg (at right), clinical associate professor of medicine and deputy chief medical officer for UMass Medical School’s Commonwealth Medicine division, said that it was critical to have a behavioral health specialist immediately begin counseling the couple following their diagnosis.

That coordination would not have existed if Steinberg’s practice was not a medical home, one of 44 participants in the multi-payer Massachusetts Patient-Centered Medical Home Initiative (MA-PCMHI) sponsored by the Massachusetts Office of Health and Human Services.

“When I describe the patient-centered medical home to practices, providers, or to anyone—all of us are patients at one point or another—I like to say it’s really the way we, as patients, would like to see our care delivered,” Steinberg told Medical Economics.

“It makes such perfect sense that our care is focused on us as an entire individual, not as individual diseases or organ systems. That our care is well-coordinated and communicated across many settings and there’s an attention to quality and we are all partners in our care.”

The article, “Patient-centered medical home: Making care coordination work for your practice,” also included insight from Christine Johnson, PhD, PCMH quality improvement and transformation director at Commonwealth Medicine. She described how a physician reluctant to use care managers grew to appreciate them after they assisted in handling a complicated post-hospitalization patient. The physician said it was like “going from baggage to first class,” Johnson said.

Commonwealth Medicine is leading the development of the patient-centered medical home model and helping practices turn it into a reality. Led by Steinberg, Commonwealth Medicine has partnered with Bailit Health Purchasing LLC on MA-PCMHI. The three-year multi-payer demonstration concluded on March 31, 2014 and is in the analysis stage. Early results show 43 of 44 practices received National Committee for Quality Assurance PCMH recognition. Statistically significant improvement was shown in 11 of 22 clinical quality measures, including chronic disease management, prevention and care coordination. A complete evaluation and report is expected in the fall of 2014.

http://www.umassmed.edu/news/news-archives/2014/06/Medical-Economics-Steinbergs-practice-is-textbook-example-of-patient-centered-medical-home/

ICD-10 Medical Code Tests Yield Successful Results for CMS

The Centers for Medicare and Medicaid Services’ claims acceptance rates approached the average for normal claims, and participants were able to test the impact of errors in claim reports during the process.

The Centers for Medicare and Medicaid Services’ initial testing of updated medical diagnosis codes that will be required at health care payers and providers next year proved to be successful, according to Niall Brennan, the acting director of CMS Offices of Enterprise Management.

The updated codes, ICD-10, replace ICD-9 to bring the U.S. up to speed with other industrialized countries and allow for more specific patient diagnoses.

After several delays, the implementation of ICD-10 will be required by Oct. 1, 2015.

All entities covered by the Health Insurance Portability and Accountability Act must implement the new codes to create consistency between the health care system in the United States and other industrialized countries.

Brennan, in a CMS blog post, said testers submitted more than 127,000 claims with ICD-10 codes to the Medicare Fee-for-service (FFS) claims systems and received electronic acknowledgments confirming their claims were accepted.

There were approximately 2,600 participating providers, suppliers, billing companies and clearinghouses during the week of testing, according to Brennan.

The largest testing group was from clearinghouses, which submit claims on behalf of health care providers, Brennan said. They submitted 50 percent of all the test claims.

In the U.S., CMS accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent, according to Brennan. Medicare FFS claims system did not present any issues during the testing process. Normal claims acceptance rates average between 95 and 98 percent.

“This testing week allowed an opportunity for testers and CMS alike to learn valuable lessons about ICD-10 claims processing,” Brennan said. “In many cases, testers intentionally included such errors in their claims to make sure that the claim would be rejected, a process often referred to as negative testing.”

In the near future, the Department of Health and Human Services expects to release an interim final rule that will include a new compliance date requiring the use of ICD-10 beginning Oct. 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9- through Sept. 30, 2015.

CMS will be releasing details about plans to conduct end-to-end testing in 2015, according to Brennan.

http://www.acainternational.org/healthcaremarket-icd-10-medical-code-tests-yield-successful-results-for-cms-32186.aspx

Empowering Engagement through the Adoption of Patient Portals

Who is using your patient portal? What is the health literacy of your population? Has your organization reaped the incredible benefits of actively engaged patients? If not, the time to act is now!

Patients who have more knowledge, skill, and confidence in managing their health, and who are more adept at navigation and using the health care system, appear to incur lower costs.

According to the Robert Wood Johnson Foundation, people who are actively engaged in their health care are more likely to stay healthy, while those who lack the skills and confidence to manage their own care often require more of it and incur up to 21 percent higher health care costs.

Utilization of patient portals is also a key exercise for satisfying Meaningful Use (MU) requirements.

Now patients must participate in order for the EP to meet Meaningful Use Stage 2.

Consider these new measures for 2014:

• More than 5% of patients must send secure messages to their EP
• More than 5% of patients must access their health information online (via a patient portal)

Are you satisfied with your Return on Engagement?

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Consider the power of a universal language such as games...

A recent study from the American Journal of Preventative Medicine examined the effects of gaming on health outcomes, and video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. 

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Whistleblower suit says health plan cheated government out of more than $1 billion

Josh Valdez took an executive level job in April 2010 expecting to improve medical services at two Puerto Rican Medicare Advantage health plans owned by a subsidiary of New Jersey company: Aveta Inc.

But a few months after coming on board, the former government health official claims, he discovered that the plans — MMM Healthcare and PMC Medicare Choice — had been cheating Medicare out of hundreds of millions of dollars for years,according to a whistleblower lawsuit he filed in federal court.

Valdez accuses the health plans of “rampant fraud,” alleging they overcharged Medicare $300 million to $350 million a year from 2007 through 2010. He claims that Aveta Chief Executive Officer Richard Shinto fired him “in retaliation for his outspoken opposition to these illegal practices.” Valdez filed the lawsuit in Santa Ana, California, in April 2011, but it remained under court seal until February of this year. The case is pending.

In a May 23 statement to the Center for Public Integrity, the health plans called Valdez a “former disgruntled employee” and added that the company “categorically denies the allegations in the former employee’s lawsuit and is highly confident that it will prevail in the case.”

Valdez is a veteran health care executive and consultant who headed the California regional office of the U.S. Department of Health and Human Services from 2001 through 2003 under President George W. Bush. He also was a health policy adviser to Republican Mitt Romney during the 2012 presidential race.

Valdez said in court papers that he served as president of MSO of Puerto Rico, also owned by a subsidiary of Aveta, for eight months until his dismissal in December 2010. MSO worked with local doctors to coordinate coverage for some 230,000 elderly and disabled people then enrolled in those two Aveta-related Medicare Advantage health plans. In a press release touting his hire, Aveta said Valdez would enhance medical care while “effectively managing healthcare costs.”

Aveta’s Puerto Rico health plans and MSO are now operated by InnovaCare Health Solutions, according to the firm’s website. InnovoCare has the same Fort Lee, N.J. office and phone number as Aveta. Several members of the Aveta board, including founding principal investor Daniel E. Straus, have been affiliated with both companies. Innovacare general counsel Christopher J. Joyce declined to discuss the corporate structure.

Straus, a prominent investor in several health-care businesses, also has worked with hedge funds and as a New York City real estate developer. Joyce said Straus would have no comment.

The whistleblower suit is significant not only for the magnitude of overbilling it alleges. It also raises questions about federal oversight of billing practices by health plans that contract with the government to cover nearly 16 million Americans, at a cost expected to top $150 billion this year.

The federal government paid the two Puerto Rico plans a total of between $1 billion and $1.8 billion annually from January 2007 through December 2010, according to the suit. Up to $350 million a year was for bills that were “improperly inflated,” according to Valdez.

Valdez argues that the health plans sought out chronically ill patients, who command the highest Medicare payment rates, but overcharged for them by manipulating a billing formula known as a “risk score.” Medicare sets risk scores for all patients based on medical data submitted by the health plans that indicates how sick patients are. Sicker patients mean higher rates.

These scores “were false or fraudulent because they were based on diagnosis codes that were not substantiated by the medical records or by the medical conditions of the Medicare beneficiaries served by the plans,” the suit states.

Valdez said he was told by top executive Shinto in May 2010 that an internal audit of medical records had confirmed that two-thirds of patient risk scores could not be supported.

According to Valdez, the audit results were discussed at several executive-level meetings, including some at which top brass talked about setting up a reserve fund in case federal officials should conduct their own review and demand refunds.

At a July 2010 meeting, Penelope Kokkinides, Aveta’s chief operating officer, allegedly said the company would be “screwed” if it was audited by the federal Centers for Medicare and Medicaid Services, especially if the review reached back to 2007. She said overcharges had been “particularly egregious” that year, as the suit paraphrased her alleged remarks.

Kokkinides estimated the liability to the government was as high as 20 percent of its total Medicare payment, or about $350 million a year, Valdez alleges. Kokkinides would not comment on the suit.

During his tenure there, Valdez said, company officials gave no indication they would “notify CMS of the problem or return the improperly obtained funds to the government,” according to the suit. CMS regulations not only require Medicare Advantage plans to attest that risk data they present for payment are accurate but also obligate them to return any overpayments they discover.

Still, CMS largely trusts the nation’s 700 Medicare Advantage plans to report risk scores accurately and honestly — and conducts only a smattering of yearly audits. There’s no indication that CMS officials reviewed the risk scores for the two Puerto Rican plans. In its 2012 annual financial report to insurance officials in Puerto Rico, MMM Healthcare stated that it had not been subject to a CMS payment audit.

However, in late March of 2011, Valdez said he took his allegations to the U.S. Attorney’s Office for the central district of California, which has since launched an investigation. That investigation “has not been completed,” government lawyers wrote in a January 2014 court filing.

Valdez blamed the faulty risk scores on errors in “medical status visit” forms filled out by the plans’ doctors. The visits were done to help identify “high risk” members and maximize payments for them. Doctors participated in a profit sharing arrangement that paid them 50 percent to 60 percent of surplus money that came in from Medicare as a result of the annual visits, according to the suit.

The lawsuit alleges that company officials failed to take “corrective measures to delete or filter out” inaccurate codes, although they knew the doctors had an incentive to inflate them.

In July 2010, executives decided to hold onto millions of dollars in these payments to the doctors in case CMS auditors required the company to repay money, according to the suit.

That concern didn’t dissuade company officials from borrowing $100 million, which was used to pay a dividend to investors, “the largest of whom was founder and Chairman Daniel E. Straus,” according to the suit. Valdez said he objected to paying the dividend while the potential liability to the government “remained unaddressed.”

http://www.publicintegrity.org/2014/06/04/14841/whistleblower-suit-says-health-plan-cheated-government-out-more-1-billion

HHS releases new data and tools to increase transparency on hospital utilization and other trends

Data can help improve care coordination and health outcomes for Medicare beneficiaries

With more than 2,000 entrepreneurs, investors, data scientists, researchers, policy experts, government employees and more in attendance, the Department of Health and Human Services (HHS) is releasing new data and launching new initiatives at the annual Health Datapalooza conference in Washington, D.C.

Today, the Centers for Medicare Medicaid Services (CMS) is releasing its first annual update to the Medicare hospital charge data, or information comparing the average amount a hospital bills for services that may be provided in connection with a similar inpatient stay or outpatient visit. CMS is also releasing a suite of other data products and tools aimed to increase transparency about Medicare payments. The data trove on CMS’s website now includes inpatient and outpatient hospital charge data for 2012, and new interactive dashboards for the CMS Chronic Conditions Data Warehouse and geographic variation data. Also today, the Food and Drug Administration (FDA) will launch a new open data initiative. And before the end of the conference, the Office of the National Coordinator for Health Information Technology (ONC) will announce the winners of two data challenges.

“The release of these data sets furthers the administration’s efforts to increase transparency and support data-driven decision making which is essential for health care transformation,” said HHS Secretary Kathleen Sebelius.

“These public data resources provide a better understanding of Medicare utilization, the burden of chronic conditions among beneficiaries and the implications for our health care system and how this varies by where beneficiaries are located,” said Bryan Sivak, HHS chief technology officer. “This information can be used to improve care coordination and health outcomes for Medicare beneficiaries nationwide, and we are looking forward to seeing what the community will do with these releases. Additionally, the openFDA initiative being launched today will for the first time enable a new generation of consumer facing and research applications to embed relevant and timely data in machine-readable, API-based formats."

2012 Inpatient and Outpatient Hospital Charge Data

The data posted today on the CMS website provide the first annual update of the hospital inpatient and outpatient data released by the agency last spring. The data include information comparing the average charges for services that may be provided in connection with the 100 most common Medicare inpatient stays at over 3,000 hospitals in all 50 states and Washington, D.C. Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for those items or services.

With two years of data now available, researchers can begin to look at trends in hospital charges. For example, average charges for medical back problems increased nine percent from $23,000 to $25,000, but the total number of discharges decreased by nearly 7,000 from 2011 to 2012.

In April, ONC launched a challenge – the Code-a-Palooza challenge – calling on developers to create tools that will help patients use the Medicare data to make health care choices. Fifty-six innovators submitted proposals and 10 finalists are presenting their applications during Datapalooza. The winning products will be announced before the end of the conference.

Chronic Conditions Warehouse and Dashboard

CMS recently released new and updated information on chronic conditions among Medicare fee-for-service beneficiaries, including:

• Geographic data summarized to national, state, county, and hospital referral regions levels for the years 2008-2012;
• Data for examining disparities among specific Medicare populations, such as beneficiaries with disabilities, dual-eligible beneficiaries, and race/ethnic groups;
• Data on prevalence, utilization of select Medicare services, and Medicare spending;
• Interactive dashboards that provide customizable information about Medicare beneficiaries with chronic conditions at state, county, and hospital referral regions levels for 2012; and
• Chartbooks and maps.

These public data resources support the HHS Initiative on Multiple Chronic Conditions by providing researchers and policymakers a better understanding of the burden of chronic conditions among beneficiaries and the implications for our health care system.

Geographic Variation Dashboard

The Geographic Variation Dashboards present Medicare fee-for-service per-capita spending at the state and county levels in interactive formats. CMS calculated the spending figures in these dashboards using standardized dollars that remove the effects of the geographic adjustments that Medicare makes for many of its payment rates. The dashboards include total standardized per capita spending, as well as standardized per capita spending by type of service. Users can select the indicator and year they want to display. Users can also compare data for a given state or county to the national average. All of the information presented in the dashboards is also available for download from the Geographic Variation Public Use File.

Research Cohort Estimate Tool

CMS also released a new tool that will help researchers and other stakeholders estimate the number of Medicare beneficiaries with certain demographic profiles or health conditions. This tool can assist a variety of stakeholders interested in specific figures on Medicare enrollment. Researchers can also use this tool to estimate the size of their proposed research cohort and the cost of requesting CMS data to support their study.

Digital Privacy Notice Challenge

ONC, with the HHS Office of Civil Rights, will be awarding the winner of the Digital Privacy Notice Challenge during the conference. The winning products will help consumers get notices of privacy practices from their health care providers or health plans directly in their personal health records or from their providers’ patient portals.

OpenFDA

The FDA’s new initiative, openFDA, is designed to facilitate easier access to large, important public health datasets collected by the agency. OpenFDA will make FDA’s publicly available data accessible in a structured, computer readable format that will make it possible for technology specialists, such as mobile application creators, web developers, data visualization artists and researchers to quickly search, query, or pull massive amounts of information on an as needed basis. The initiative is the result of extensive research to identify FDA’s publicly available datasets that are often in demand, but traditionally difficult to use. Based on this research, openFDA is beginning with a pilot program involving millions of reports of drug adverse events and medication errors submitted to the FDA from 2004 to 2013. The pilot will later be expanded to include the FDA’s databases on product recalls and product labeling.

For more information about CMS data products, please visit http://www.cms.gov/Research-Statistics-Data-and-Systems/Research-Statistics-Data-and-Systems.html.

For more information about today’s FDA announcement visit:

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM399335 or http://open.fda.gov/

CMS Advises Delay in ICD-10 Front-End Testing Until October

Providers, suppliers, billing companies and clearinghouses can submit ICD-10 acknowledgement test claims anytime up to the new planned October 1, 2015 ICD-10 implementation date. However, the Centers for Medicare and Medicaid Services is advising stakeholders to delay this front-end testing until after October 6, 2014, when Medicare is scheduled to update its systems.

A May 30 announcement from Niall Brennan, acting director of the CMS Offices of Enterprise Management, recommended that submitters contact their local Medicare Administrative Contractor for additional information about ICD-10 acknowledgment testing, which will allow providers, suppliers, billing companies and clearinghouses the opportunity to determine whether CMS will be able to accept their claims with ICD-10 codes.

In March, Brennan said that CMS successfully conducted a week of ICD-10 testing for more than 127,000 claims that were submitted with ICD-10 codes to the Medicare Fee-for-service claims systems and which received electronic acknowledgements confirming that their claims were accepted. He reported that about 2,600 participating providers, suppliers, billing companies and clearinghouses participated in the test week--representing about five percent of all submitters--and that this testing did not identify any issues with the Medicare FFS claims systems. 

Brennan also informed stakeholders that CMS will be conducting end-to-end ICD-10 testing in 2015. "Details about this testing will be released soon," he said. In May, CMS canceled limited end-to-end testing that had been scheduled for late July, when CMS planned to give a small sample group of providers the opportunity to participate in end-to-end testing with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor.

The Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date requiring the use of ICD-10 beginning October 1, 2015. The rule will require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015. Last week, CMS announced that the partial code freeze for ICD-9-CM and ICD-10 will continue through October 1, 2015.

http://www.healthdatamanagement.com/news/CMS-Advises-Delay-in-ICD-10-Front-End-Testing-Until-October-48169-1.html

(CMS–10340) Collection of Encounter Data From Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations

SUPPLEMENTARY INFORMATION:

Contents:

This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection’s supporting statement and associated materials (see ADDRESSES).

CMS–10340 Collection of Encounter Data From Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations

CMS–10380 Reporting Requirements for Grants to States for Rate Review Cycle I, Cycle II, Cycle III, and Cycle IV and Effective Rate Review Program Under the Paperwork Reduction Act (PRA) (44 U.S.C. 3501–3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor.

The term ‘‘collection of information’’ is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party.

Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice.

Information Collection

1. Type of Information Collection

Request:

Extension of a currently approved collection; Title of Information Collection: Collection of Encounter Data from Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations;

Use:

CMS collects encounter data or data on each item or service delivered to enrollees of Medicare Advantage (MA) plans offered by MA organizations. MA organizations currently obtain this data from providers. CMS collects this information using standard transaction forms and code sets.

CMS will use the data for determining risk adjustment factors for payment, updating the risk adjustment model, calculating Medicare DSH percentages, Medicare coverage purposes, and quality review and improvement activities.

The data is also used to verify the accuracy and validity of the costs claimed on cost reports.

For PACE organizations, encounter data would serve the same purpose it does related to the MA program and would be submitted in a similar manner.

Form Number: CMS–10340 (OCN: 0938– 1152); Frequency: Weekly; Affected Public: Private sector (business or other for-profits); Number of Respondents: 683; Total Annual Responses: 516,493,635; Total Annual Hours: 34,433 (For policy questions regarding this collection contact Michael Massimini at 410–786–1566).

2. Type of Information Collection

Request: Revision of a currently approved collection; Title of Information Collection: Reporting Requirements for Grants to States for Rate Review Cycle I, Cycle II, Cycle III, and Cycle IV and Effective Rate Review Program; Use: Under the section 1003 of the Affordable Care Act (ACA) (section 2794 of the Public Health Service Act), the Secretary, in conjunction with the states and territories, is required to establish a process for the annual review, beginning with the 2010 plan year, of unreasonable increases in premiums for health insurance coverage.

Section 2794(c) requires the Secretary to establish the Rate Review Grant Program to assist states to implement this provision. In addition, section 2794(c) requires the Rate Review Grant Program to assist states in the establishment and enhancement of ‘‘Data Centers’’ that collect, analyze, and disseminate health care pricing data to the public.

Concurrent with this information collection request, HHS released Cycle IV of the Rate Review Grants, ‘‘Grants to States to Support Health Insurance Rate Review and Increase Transparency in the Pricing of Medical Services.’’ 

The purpose of Cycle IV of the Rate Review Grant Program is to continue the rate review successes of Cycles I, II, and III, as well as to provide greater support to Data Centers, thereby enhancing medical pricing transparency. States and territories that apply for funds are required to complete the grant application. 

States and territories that are awarded funds under this funding opportunity are required to provide the Secretary with rate review data, four quarterly reports, and one annual report per year until the end of the grant period detailing the state’s progression towards a more comprehensive and effective rate review process. A final report is due at the end of the grant period.

This information collection is required for effective monitoring of grantees and to fulfill statutory requirements under section 2794(b)(1)(A) of the ACA that requires grantees, as a condition of receiving a grant authorized under section 2794(c), to report to the Secretary information about premium increases.

On May 23, 2011, CMS published a final rule with comment period (76 FR 29964) to implement the annual review of unreasonable increases in premiums for health insurance coverage called for by section 2794. Under the regulation, if CMS determines that a state has an Effective Rate Review Program in a given market, using the criteria set forth in the rule, CMS will adopt that state’s determinations regarding whether rate increases in that market are unreasonable, provided that the state reports its final determinations to CMS and explains the bases of its determinations.

 The final rule titled ‘‘Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review’’ (78 FR 13406, February 27, 2013) amends the standards under the Effective Rate Review Program. Currently, CMS relies on publicly available information and annual calls with individual states to obtain the information needed to evaluate whether a state has begun to or continues to satisfy the Effective Rate Review Program criteria. CMS is proposing to instead collect the information in writing from all states that would like to request effective status.

Form Number: CMS–10380 (OCN: 0938–1121); Frequency: Annually and On occasion; Affected Public: Public Sector and State and Territory Governments; Number of Respondents: 50; Total Annual Responses: 553; Total Annual Hours: 20,951. (For policy questions regarding this collection contact Susie Lorden at 301–492–4162.)

Dated: May 28, 2014. Martique  Jones, Deputy Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.

http://www.regulations.gov/#!documentDetail;D=CMS-2014-0073-0001

NHS staff working together to improve care

Staff are working together to improve care

MORE than 7,650 NHS Wales staff have completed the first level of the national learning programme Improving Quality Together, according to new figures.

The scheme, which provides staff, contractors, managers and board members with skills that will help them improve the care delivered to patients, has been completed at the first level by 7,654 people in the past 15 months.

There are three levels to the programme, launched in March 2013, and it is led by 1,000 Lives Improvement, which is part of Public Health Wales.

Staff complete the bronze level through a series of online modules, with the silver level providing an opportunity to develop and implement improvement projects. The gold level is establishing a network of improvement coaches and there is additional training for board members.

Dr Alan Willson, director of 1,000 Lives Improvement, said: "Improving Quality Together is providing staff with the knowledge and expertise to continue improving our services, so that they are the safest and most efficient they can be.

"We are already seeing the benefits of staff speaking a common language of improvement as they work towards the same goals - improved patient experience and outcomes."

"We are delighted that so many NHS Wales staff have completed at least the bronze level of Improving Quality Together and are looking forward to even more colleagues signing up to the learning programme."

In Aneurin Bevan University Health Board, cleaner operating theatres have lead to safer care under the scheme.

Nurse Helen Dinham used the skills she learnt to reduce surgical site infections, by improving the standard practice of cleaning in orthopaedic theatres in the health board.

Improving Quality Together helped her team address the obstacles that were preventing the correct level of cleaning taking place, such as standardising equipment and amended policies.

The outcome of the project was 100% compliance with the cleaning requirements, meaning infection risks were reduced and patients would recover more quickly.

She said: "Reaching our target was very good for staff morale and has reassured patients that the quality of care and the standard of cleanliness in orthopaedic theatres is excellent."

In ABMU Health Board, they looked at improving patient flow and communication on hospital wards.

Reducing delays in a patient's journey and improving communication on hospital wards are just two of the key benefits gained from Jo Rowland's silver project in the Princess of Wales Hospital, Bridgend.

The assistant head of physiotherapy used her Improving Quality Together training to implement daily ward rounds to discuss each patient and find out the next step needed.

Reporting back findings on a daily basis has increased efficiency and resulted in reduced lengths of stay in hospital and improved patient flow through the wards.

It has also provided a consistent approach, which has improved communication between staff, patients and their families.

Meanwhile, Cardiff and Vale University Health Board has improved access to dental services for patients in prison Head of primary care service delivery Rhian Blake used her silver training to improve access to dental services for patients at Her Majesty's Prison in Cardiff. In the past 18 months the profile of the prison population had changed significantly, with more individuals on remand and shorter sentences.

As a result, many patients had incomplete dental treatment, or didn't receive the required treatment in a timely fashion.

Rhian used the programme's methodology to analyse the problem and find solutions, which included the immediate allocation of appointments when needed, and a quicker triage process. The changes led to a reduction in complaints and fewer missed appointments.

http://www.walesonline.co.uk/news/health/nhs-staff-working-together-improve-7203178