The ‘Whys’ and ‘Hows’ of Starting an Anesthesia Quality Program, Part 2
As we noted in last week's eAlert on developing an anesthesia quality program, the need for anesthesia practices to demonstrate quality to their facilities has become virtually as important as getting paid for services.
We touched on some of the key points from the talk by Spiro G. Spanakis, DO, at PRACTICE MANAGEMENT™ 2019 regarding the reasons why anesthesia groups need a quality program, as well as some of the tenets for establishing a program that works. This week we will explore how anesthesia groups can decide what to measure.
As a 2017 article in the ASA Monitor observed, though anesthesiologists might see quality measures as a means to satisfy MIPS reporting requirements, "a well-designed quality measure has the dual potential to drive real improvements in patient care at the local level in addition to satisfying regulatory reporting requirements."
Quality measures that reflect the nuances and realities of modern anesthesia practice are the purpose of the anesthesia Qualified Clinical Data Registries (QCDRs) that have been developed by various organizations, including the anesthesia QCDR developed by ABC's parent company, MiraMed Global Services, as part of its MACRA MadeEasy platform. We encourage anesthesia practices to refer to these CMS-approved measures as a jumping off point for quality reporting as well as pursuing additional practice-specific measures as needed through the various channels recommended here by Dr. Spanakis.
The specific aspects of quality to measure will always be in a state of flux, and though that constant change can be frustrating for physician champions and anesthesia groups, "it's the name of the game and the world we live in," said Dr. Spanakis, who practices at UMass Memorial Medical Center and serves on the ASA Committee on Patient Safety and Education.
Because quality improvement has become a permanent, integral and essential aspect of anesthesia practice, creating and sustaining an effective quality program "is going to be a continual process and a continual cycle," Dr. Spanakis said.
The first step in embarking on a quality program is to decide where to focus and define what you're trying to improve, he said. Possibilities might include practice-specific problems at a particular site, obligations related to service-level agreements or aspects of Ongoing Professional Practice Evaluations (OPPE).
It's important to identify what data is already available because "it's actually very difficult to gather data on your own," he added. The various quality data registries with which many hospitals participate offer a good source. "You need to become friends with the people who are managing those registries, look at that data and see how it reflects on your department," he said.
For anesthesia practices just starting out, Dr. Spanakis also suggested reviewing the group's billing data to determine the most common type of case. Zeroing in on quality measures related to these procedures "is an area where you can actually make a great impact," he said. [ABC clients: Your account executive can prepare a report of your group's most frequently performed procedures upon request.]
Other sources include the Joint Commission, your institution's Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, which "are being factored into contracts with individual groups and hospitals," and medical societies, including, but not limited to, the ASA. "Collaborate with your surgeons and see what their professional societies are doing to give you ideas for future performance," he said. "It's important to identify which areas need the most attention and the most help."
Dr. Spanakis advised sifting through the wealth of information that is available on PubMed and similar sources to see what anesthesia groups have already done. He also recommended the ASA's five-step process for developing quality measures as a framework that anesthesia practices can implement in their own departments, as well as the Anesthesia Patient Safety Foundation's 2018 list of perioperative patient safety priorities.
Dr. Spanakis's department is focusing on the use of neuromuscular blockade, among other things, because postoperative respiratory failure is one of the Patient Safety and Adverse Events Composite (PSI 90) indicators and is well-documented as an important ongoing safety concern in anesthesia.
Prioritize what's important to your department and your institution, he advised, and always do a small pilot and a test of change for any improvements you're planning on implementing to make sure that your measure is going to work the way you intended.
After you're done with your project, continuously measure and assess your intervention's impact, and demonstrate your work to hospital leadership, departmental leadership and the department itself. Finally, access quality registries to benchmark your work against other institutions, and repeat the cycle as new measures come up.
Dr. Spanakis shared the well-known quote from William A. Foster to sum up: "Quality is never an accident. It's always the result of high intention, sincere effort, intelligent direction and skillful execution."
For more information on the MiraMed QCDR, please call the MACRA MadeEasy hotline at (517) 962-7301.
We want to hear from you. Do you have a topic you would like to see covered in an ABC eAlert? Please send your suggestions to info@anesthesiallc.com.
With best wishes,
Tony Mira
President and CEO