1. QUALITY AND YOU GUIDE for New Physicians, Dentists, Podiatrists, and Extenders

2. WHO’S WATCHING?  The Public  CMS  Insurers  The Joint Commission  Georgia Medical Care Foundation  Others (NHSN, Leapfrog, etc…)

3. 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

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5. 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

6. 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)

7.  Pneumococcal  Influenza: October- March Immunization

8. 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

9. HEART FAILURE  Left ventricular function (LVF) assessment  Detailed discharge instructions  ACE or ARB Inhibitor for LVSD  Smoking cessation information given and document

10. 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

11. 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

12. Initial VTE Prophylaxis ICU VTE Prophylaxis Patients on Overlap Therapy Platelet Count for Heparin Infusion Coumadin Education at Discharge Hospital Acquired VTE VTE/DVT

13. CMS OUTPATIENT PROJECT  AMI  Chest Pain  Colonoscopy timing  Emergency Department  Outpatient Surgery  Pain Management Long Bone Fractures  Stroke

14. READMISSIONS There is potentially as high as a 3% of all Medicare payment penalty for Readmissions within thirty days of discharge.

15. Mortality Focus  AMI  Cardiac Surgery  COPD  Heart Failure  Pneumonia  Stroke

16. 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

17. 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.

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21. 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

22. 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.

23. 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: drmike@sjchs.org

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