Julie L. Hopkins, MA, MBA Vice President, Hospital & CME Programs Institute for Medical Quality

QICME In the beginning… Relationship: Informal, Not Strategic ©iMQ|2011

 Professional Accountability ◦ Maintenance of Certification (MOC) ◦ Maintenance of Licensure (MOL)  Public Accountability ◦ 2008 Senator Grassley, (US Senate Finance Committee) questions medical societies about corporate support from pharmaceutical and medical device companies ◦ Effective December 4, 2007 under Stark Law II: CME becomes a perk!  Intent: To ensure no wrongdoing by nature of the relationship, e.g., enticing physicians to refer more Medicare/ Medicaid patients to a hospital by giving them lots of perks ©iMQ|2011

 Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support sm  PHARMA & medical device companies ◦ Reduced and restructured CME support ◦ Moved from Marketing to grants/foundations  2011 AMA passes CEJA recommendation further restrict commercial interests and CME ©iMQ|2011

 ACCME 2006 Elements and Criteria  AMA 2010 changes to PRA Category 1 Credits

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Links between quality & reimbursement start to matter more ©iMQ|2011

 Meaningful Use – $40B HIT and EHR stimulus  Value-Based Purchasing – Quality and HCAHPS ◦ Move from pay for data to pay for performance ◦ Processes and outcome transparency ◦ Data to coordinate care ◦ Readmission Reduction Program ◦ Patient-Centered Medical Homes ◦ IHI + AHRQ: Value = Quality/Cost ◦ Data to reduce costs and maintain margin ◦ Bundled Payments ◦ Accountable Care Organizations (ACOs)

Why? Because you can: 1. Have the most influence on improving patient care at the point it is delivered 2. Focus on what needs improvement 3. Measure impact/results and determine what worked/didn’t work 4. ? 5. ?

1. National Quality Statistics & Goals 2. Organizational Quality Goals/Performance 3. Best Practices

 The Centers for Disease Control and Prevention (CDC) estimates annually: ◦ At least 1.7 million healthcare-associated infections occur leading to 99,000 deaths ◦ 1in every 20 hospitalized patients in US acquires a healthcare-associated infection ◦ Of these, central intravenous line associated blood-stream infections (CLABSIs) are most deadly: mortality rate of 12-25%

How do national statistics or goals impact local quality and CME? ©iMQ|2011

 2006 AHRQ funded Michigan Keystone Intensive Care Unit Project (Keystone Project)  Partnership: Johns Hopkins University & Michigan Health and Hospital Association  Results: ◦ Reduced rate of CLABSIs by 2/3 in 3 months ◦ In18 months saved more >1,500 lives and nearly $200 million ◦ 2011: improvement Sustained ©iMQ|2011

 2011: Awards $34 Million To Expand Fight  Projects: SPREAD use of Comprehensive Unit-based Safety Program (CUSP) modules  Since 2008: AHRQ has promoted nationwide adoption of CUSP to reduce CLABSIs  New modules target 3 additional infections: ◦ Catheter-associated urinary tract infections ◦ Surgical site infections ◦ Ventilator-associated pneumonia ©iMQ|2011

 Translate national statistics and goals into local CME and Quality Initiatives  Education – a key component but not only component to achieve results  Education delivered at local level, where it makes a difference  Quality/Patient Safety is measured locally, but compared to national or regional results ©iMQ|2011

Does your organization measure National Quality Goals because of public awareness ora desire to improve performance? ©iMQ|2011

 What are the quality/patient safety goals or targets for your: ◦ Hospital? ◦ Department/Divisions? ◦ Clinics ◦ Medical Groups? ©iMQ|2011

 What gap must be closed to achieve the goal?  Example: Improve percentage of patients evaluated for osteoporosis  Target: 85%  Current Performance: 50% ©iMQ|2011

 What causes the gap: e.g., ◦ Systems ◦ Education ◦ Resources  Example: What are underlying causes for patients not being evaluated for osteoporosis ©iMQ|2011

 Are there educational needs (knowledge/competency/skill) that, if met, will close or help to close the gap/achieve the goals?  Example: Can any of the underlying causes for patients not being evaluated for osteoporosis be addressed through CME? ©iMQ|2011

 Guidelines from specialty organizations  Changes in techniques, processes or decisions based on evidence emerging from research or studies (e.g., Keystone Project)  New technology that reduces risk to patient ©iMQ|2011

 What relevant best practices are: o Emerging in the services your organization provides? o Known but have not been widely adopted in your organization? ©iMQ|2011

 Recent studies show lower complication and readmission rates  Attributed to wide adoption of best practices  How does your organization compare?  How can CME help?  Example, specialty hospital conducting CME for medical staff at rural referral hospitals

 How do you gain adoption… SPREAD …those best practices across a specialty/organization?  Can CME play a role in expediting adoption of a best practice among your peers in your organization?  Are there quality measures or goals related to this best practice that would benefit from its wide-spread adoption? ©iMQ|2011

QI measure Best Practice National Statistic ? New / equipment or change in process ©iMQ|2011

QI Measure How to close gap? Need for EDU? Design/Deliver CME Desired Results? ©iMQ|2011

How do you know what worked ©iMQ|2011

 QI/PI data source used to identify gaps/learning needs is used to determine effectiveness of CME  Take credit, even when achievement was multifaceted  Document analysis, decisions, not just data

For all you do, everyday, to make life better for so many. ©iMQ|2011