MEASURING AND DEMONSTRATING QUALITY - ON YOUR TO-DO LIST
May 4, 2009
The Announcement sent to our readers last week addressed the general question, “Where Does Your Anesthesia Practice Find the Data?” We discussed three different sources of practice management data and their relative usefulness: data generated by your practice; data from other anesthesia practices, particularly those collected in the MGMA-AAA Cost Survey of Anesthesia Practices (and if you are still thinking of completing the 2009 questionnaire, please contact Brenda Dorman, AAA President, firstname.lastname@example.org today!), and lastly, national data.
The last few years have seen an explosion of interest not just in practice and operating room management information, but also in data that tend to demonstrate quality. Putting aside the contentious issue of whether the indicators that we will discuss actually measure and improve the quality of anesthesia care or pain medicine, we must acknowledge the importance of those indicators. Everyone has heard that payment for medical services is going to be value-based if it isn’t already. “Value” is often defined as the relationship between cost and quality. If the cadaver ligament was successfully grafted on to the patient’s knee, but the patient died of preventable sepsis, the value of the procedure was hardly equal to the hospital and physician charges.
Hospitals and some primary care practices are already receiving financial incentives for improving outcomes, or at least for reporting high rates of performance of quality interventions. Anesthesiologists are some of the many types of physician who have not yet entered the realm of pay-for-performance, but we have quickly become accustomed to pay-for-reporting through the Medicare Physician Quality Reporting Initiative (PQRI). This year, anesthesiologists can earn a bonus equal to two percent of their Medicare allowables by successfully reporting on PQRI Measure #30, Timing of Prophylactic Antibiotics – Administering Physician, and/or Measure #76, Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol. A number of measures are available for reporting by physicians who limit their practice to pain medicine, including those relating to tobacco use counseling and to the implementation of an electronic medical record system in one’s practice.
Recently hospitals have been asking anesthesiology groups that are seeking financial support to describe quality indicators on which the groups are measuring themselves, or on which they wish to be measured. There are multiple reasons for the hospitals’ heightened interest: (1) the wish to receive some new benefit or “consideration” in exchange for the payment sought; (2) recognition of anesthesiology’s role in allowing the hospital to achieve decent scores on the Surgical Care Improvement Project (SCIP) and other quality measures that are required for the full annual Medicare payment update, and (3) Joint Commission requirements, to name a few. (Two key Joint Commission Medical Staff standards that went into effect in January 2008, the Focused Professional Practice Evaluation (FPPE) and the Ongoing Professional Practice Evaluation (OPPE), require organizations to review their current process for assuring physician competence at initial appointment, when new privileges are requested, when trigger events occur, and in an ongoing manner.)
It is within the capabilities of most anesthesiologists to select either process or outcome measures and to devise a reliable method of recording and reporting the extent of compliance. In addition to the 2009 PQRI measures noted above, there are such diverse quality indicators as:
- Management of postoperative hypothermia (will be included in PQRI)
- Use of pencil-point spinal needles to reduce post-dural puncture headaches
- Providing patient education regarding postoperative analgesia
- Patient and surgeon satisfaction metrics
- Avoidance of complications (unplanned postoperative ventilation, ICU or hospital admission; return to OR; wet tap; eye or dental injury, awareness, NS injury, pneumothorax, MI, failed regional block, etc.)
For a recording/reporting system to work, i.e., to contribute to quality improvement, the system has to prove its value to the physicians who use it. The Quantum Clinical Navigation System™ is one system that has passed that test. Quantum was developed, tested in more than 14 hospitals and surgery centers over more than a decade, refined and implemented by ABC client Southeast Anesthesiology Consultants. Features and benefits of Quantum include:
- Process designed by anesthesiologists, for anesthesiologists
- 58-indicator checklist with standardized clinical definitions, plus ability to add local indicators
- Clinician-entered data throughout continuum of care
- Rapid results/feedback to clinician for early intervention
- Tracks and trends efficiency (e.g. causes for case delays), clinical quality outcomes, practitioner performance and patient satisfaction.
Such data are important today, and within the next few years their accurate reporting will make the difference between successful practices and those that cannot compete. We have made that claim before, and we have brought the Quantum Clinical Navigation System to our readers’ attention before. Today we would like to invite you to learn about Quantum for yourselves by registering for and participating in a 30-minute webinar hosted by Richard Gilbert, MD, Chair, Southeast Anesthesiology Consultants, and developer of the Quantum Clinical Navigation System. The webinar will be conducted live by Dr. Gilbert on the following dates and times:
Tuesday, May 26, 3:30 to 4:00 p.m.
Thursday, May 28, 11:30 to 12:00 a.m.
Thursday, May 28, 2:30 to 3:00
Dr. Gilbert’s participation as host will enable physician readers to obtain specific answers to your questions. We very much hope that you will take advantage of this opportunity. Please register for one of the sessions and obtain the call-in and webinar ID numbers by contacting email@example.com and including the word “Quantum” in the subject of your message, no later than May 22, 2008.
Those attending the MGMA-AAA Annual Meeting in Miami, May 17-20, will also have an opportunity to see Quantum displayed on a video monitor at the ABC booth in the Exhibit area. Please note any questions you would like Dr. Gilbert to answer and bring them up in one of the webinars – or send advance copies to firstname.lastname@example.org.
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UPDATE ON FTC’s RED FLAG RULES: The Federal Trade Commission has delayed, for the second time, the application of its “Red Flag Rules” to physicians and medical practices. These rules require practices to implement identify theft protection programs that duplicate and go beyond HIPAA Privacy mandates. The American Medical Association and other representatives of organized medicine have resisted strongly the characterization of physicians as “creditors” on the sole basis that few patients pay their full balance at the time of service. Initially enforcement was to have begun in November 2008. It was postponed until May 1st, 2009 and now it has been postponed again until August 1st. ABC was prepared to ensure clients’ compliance with the May 1st deadline, and we will make sure that our clients have up-to-date information on satisfying the Red Flag rules before enforcement finally begins – which we are assuming that it will. Summary information appeared in our March 30th “Announcement,” available from email@example.com; you may review the full regulation and the FTC’s materials at http://www.ftc.gov/opa/2009/04/redflags.shtm.
As always, we hope that the information provided in this Announcement will be helpful in your anesthesia practice.