Transcript Document

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
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System Quality Performance
Quarterly Activities: Data submission to various organizations
and agencies
 American Heart Association (AHA)
 Association for Healthcare Research
and Quality (AHRQ)
 Blue Cross/ Blue Shield Quality InSights Hospital Incentive Program (QHIP)
 American College of Cardiology
(ACC)-Percutaneous Cardiovascular
Intervention (PCI) and Implantable
Cardioverter Defibrillator (ICD)
 Center for Medicare and Medicaid
Services (CMS)
 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/Pneumonia
 Prenatal Care
 Stroke
 Stroke
 Surgical Care Improvement
Project
• CABG and other Heart
Surgery
• Vascular Surgery
• Hip and Knee Replacement
• Hysterectomy
 Venous Thromboembolism
(VTE)
Immunization
 Pneumococcal
 Influenza: October- March
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
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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
VTE/DVT
Initial VTE
Prophylaxis
ICU VTE
Prophylaxis
Patients on
Overlap
Therapy
Platelet Count
for Heparin
Infusion
Coumadin
Education at
Discharge
Hospital
Acquired VTE
CMS OUTPATIENT
PROJECT
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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.
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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 protected]
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