Presentation on theme: "QUALITY AND YOU GUIDE for New Physicians, Dentists, Podiatrists, and Extenders."— Presentation transcript:
QUALITY AND YOU GUIDE for New Physicians, Dentists, Podiatrists, and Extenders
WHO’S WATCHING? The Public CMS Insurers The Joint Commission Georgia Medical Care Foundation Others (NHSN, Leapfrog, etc…)
GOALS Highest quality of care at an acceptable price Patient satisfaction Excellent outcomes Receive bonuses and avoid financial penalties Meet publicly available measures and scores of quality
System Quality Performance American Heart Association (AHA) Association for Healthcare Research and Quality (AHRQ) Blue Cross/ Blue Shield Quality In-Sights Hospital Incentive Program (Q-HIP) American College of Cardiology (ACC)-Percutaneous Cardiovascular Intervention (PCI) and Implantable Cardioverter Defibrillator (ICD) Center for Medicare and Medicaid Services (CMS) Quarterly Activities: Data submission to various organizations and agencies Coverdell Georgia Registry of Immunization Transactions and Services (GRITS) Get With The Guidelines (GWTG) Leapfrog Society of Thoracic Surgeons (STS) The Joint Commission
CMS Inpatient Project Process Measures Acute Myocardial Infarction (AMI) Community – Acquired Pneumonia Emergency Department Inpatient/Outpatient Heart Failure Immunization/Pneumoni a Prenatal Care Stroke Surgical Care Improvement Project CABG and other Heart Surgery Vascular Surgery Hip and Knee Replacement Hysterectomy Venous Thromboembolism (VTE)
Pneumococcal Influenza: October- March Immunization
Acute Myocardial Infarction/ Heart Attack Aspirin at arrival Aspirin prescribed at discharge Beta Blocker at arrival Beta Blocker at discharge ACE or ARB inhibitor for LVSD Smoking cessation information given and documented Inpatient mortality rate Beta Blocker at Arrival Fibrinolytic Agent received within 30 minutes of hospital arrival Percutaneous Coronary Intervention (PCI) within 90 minutes of arrival
HEART FAILURE Left ventricular function (LVF) assessment Detailed discharge instructions ACE or ARB Inhibitor for LVSD Smoking cessation information given and document
Community Acquired Pneumonia Blood culture within 24 hr. of transfer or admission First antibiotic received within 4 hrs. of hospital arrival Smoking cessation information given and documented
Surgical Care Improvement Project (SCIP) Prophylactic Antibiotic received within 1 hr. prior to surgical incision Prophylactic Antibiotic selection for surgical patients Prophylactic Antibiotics discontinued within 24 hr. after surgery end Prophylactic Antibiotics discontinued within 48 hr. after surgery end (CABG and other cardiac surgeries) Appropriate Hair Removal Colorectal Surgery Patients with Immediate postoperative normothermia Surgery Patients on beta- blocker therapy prior to admission who received a beta blocker during the perioperative period Surgery Patients with recommended venous thromboembolism
Initial VTE Prophylaxis ICU VTE Prophylaxis Patients on Overlap Therapy Platelet Count for Heparin Infusion Coumadin Education at Discharge Hospital Acquired VTE VTE/DVT
CMS OUTPATIENT PROJECT AMI Chest Pain Colonoscopy timing Emergency Department Outpatient Surgery Pain Management Long Bone Fractures Stroke
READMISSIONS There is potentially as high as a 3% of all Medicare payment penalty for Readmissions within thirty days of discharge.
Mortality Focus AMI Cardiac Surgery COPD Heart Failure Pneumonia Stroke
REDUCING MORTALITY Document, Document!! Use Sepsis Bundle Promptly Order Sets Involve Palliative Care, Ethics Committee, Hospice Care when appropriate! When Appropriate, write orders for Comfort Care and DNR
What is Value Based Purchasing This is a program of CMS to reward and penalize good and “less than optimal” care of patients. This has morphed each year since inception. The most recent focus is on outcomes, patient satisfaction, process of care, safety, and efficiency and cost reduction.
Safety Concerns Examples Pressure Ulcers (not present on admission) Catheter Associated UTIs (CAUTI) Central Line Associated Bloodstream Infection (CLABSI) Accidental Punctures or Perforations Surgical Site Infections Prolonged Ventilation Clostridium Difficile
What Would We Like You To Do? Be aware of measures under scrutiny Use order sets as frequently as possible that have been vetted as “best practice” and include quality measures. Be open to suggestions from St. Joseph’s/Candler colleagues about drug choices, clarification of diagnosis, etc… Do all medical records in a timely fashion.
QUESTIONS? Put me in your cell phone: Julia L. Mikell, MD Director, System Quality Performance Office: 912-819-8558 Cell: 912-507-1501 Email Address: email@example.com