Newsletter of the American College of Medical Quality

   Fall 2015   


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In This Issue
President's Message
Quality as a Function of Systems-Based Practice
Editor's Message
Ethics Committee Update
Student/Resident Update
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Quality Links

The Los Angeles Times (4/16, McGreevy) "PolitiCal" blog reports that SB277, a bill requiring "more children to be vaccinated in California, ran into trouble Wednesday amid objections that it would force thousands of non-immunized students out of public schools." The author of the measure, Sen. Richard Pan (D-Sacramento), "agreed to delay a vote on it after being warned by the Senate Education Committee chairwoman that it would not win the panel's approval in its current form." 

The CMS' proposed payment rule for home health agencies is under fire from the industry and advocates who say it will put an unwarranted financial burden on providers and threaten patient access to care.
Providers, health officials prepare for ICD-10 switch
The AP (9/8, Neergaard) reports that things might be "a bit tense" on Oct. 1, when the "nation's physicians and hospitals must start using" the ICD-10 coding system. According to the AP, the updated system "has about 68,000 codes, essentially an expanded dictionary to capture more of the details from a patient's chart." The Federal government says the change should help officials better track quality of care and spot illness or injury trends.

For the second year, the CMS has awarded bonuses to 1 in 4 accountable care organizations working under a Medicare model intended to spur providers to deliver lower-cost care. They will share $422 million out of the $833 million they collectively saved the government in 2014.

Just how much success have hospitals had in their efforts to prevent patients from returning soon after leaving? Perhaps not as much as reported, two physicians argue at the blog for health policy journal Health Affairs. 

Three out of four Medicare accountable care organizations did not slow health spending enough to earn bonuses last year, a continuation of mixed results for an initiative that federal officials have targeted for rapid expansion. 
The Boston Globe (8/22) reported that a five-year review published in The Joint Commission Journal on Quality and Patient Safety suggests that "sharing notes...enhances patient safety and places little burden on physicians." The article examined the "OpenNotes" initiative started in 2010 by two Harvard clinicians in "an effort to make doctors' notes easily available to patients." Physicians "agreed that one of the 'best things' resulting from sharing notes was" that patients noticed errors on their charts. The OpenNotes team "is now performing a two-year study of the effects of the program on patient safety and medical errors, and is developing an online reporting tool so patients can provide feedback on their notes."

Healthcare is an economic paradox. On one hand, it's our nation's fastest-growing employer, projected to add 15.6 million jobs by 2022. On the other, high costs coupled with an aging population are breaking budgets.

Medicare's voluntary bundled-payment program grows, but many providers opt out
Medicare's voluntary test of bundled payments added new contracts in July, but about two-thirds of the hospitals, medical groups, nursing homes and other providers that had initially enrolled instead dropped out. 

Most U.S. hospitals will get less money from Medicare in fiscal 2016 because too many patients return within 30 days of discharge.

Only 799 out of more than 3,400 hospitals subject to the Hospital Readmissions Reduction Program performed well enough on the CMS' 30-day readmission program to face no penalty. Thirty-eight hospitals will be subject to the maximum 3% reduction, according to a Modern Healthcare analysis of newly posted CMS data.

USPSTF panel recommends depression screening for adults in primary care setting

Reuters (7/28, Seaman) reports that a US Preventive Services Task Force (USPSTF) panel has recommended that adults in the US should undergo depression screening in the primary care setting.

Sandeep Jauhar, a cardiologist and a contributing opinion writer, writes in a New York Times (7/22, Subscription Publication) op-ed on "surgical 'report cards,' a quality-improvement program that began in New York State in the early 1990s and has since spread to many other states." While the goal of the report cards was to improve cardiac surgery by tracking patient outcomes, the initiative "backfired," often penalizing talented surgeons "who were aggressive about treating very sick patients and thus incurred higher mortality rates." Meanwhile, Jauhar writes that "there is little evidence that the public - as opposed to state agencies and hospitals - pays much attention to surgical report cards anyway."
New International ACMQ Conference in Abu Dhabi

Prathibha Varkey MD, MPH, MHPE, MBA
ACMQ Presidnet 

We are excited to announce that in partnership with SEHA (Abu Dhabi Health Services Co.), the American College of Medical Quality (ACMQ) is  hosting a three-day Quality Improvement and Patient Safety (QIPS) conference at the Abu Dhabi National Exhibition Centre (ADNEC) 29th- 31st of October 2015.  The event launches with a pre-conference ACMQ Quality Improvement Workshop on the 29th October 2015 and is followed by a two-day Quality Improvement and Patient Safety (QIPS) Conference on 30th and 31st October 2015.  Also, for the first time outside the United States, the ABMQ Certification in Medical Quality (CMQ) Examination will be available for health care professionals to take the examination in Abu Dhabi.     
SEHA Chief Executive Officer, Dr Matar Al Darmaki states that "We are delighted to collaborate with ACMQ and ABMQ who are leading providers of education in health care quality management in the United States. Like ACMQ and ABMQ, SEHA is committed to improving health care quality and delivering high quality care to our patients".
More information and registration is available at:

Quality as a Function of Systems-Based Practice

Steven Merahn, MD
Chief Medical Officer
US Medical Management

As our health care systems evolve, our concepts of quality increasingly remind me of the story of the blind men describing an elephant.  Is it a snake?  A wall?  A rope?  HEDIS measures? CAHPS?  Readmission rates? IQR? MSSP ACO? 
And which perspective -- patients?  payers?  providers?  -- should determine the benchmarks that constitute 'value'?
While a universal perspective may be accounted for under the IHI "Triple Aim" model, in our current systems of care, payers and health plan sponsors are the drivers of what constitutes 'value'.  Today, this is largely based on cost savings in the context of a set of quality measures and patient satisfaction scores.  The quality measures all have some evidence-base for patient-centered 'value' - both in terms of actuarial value across a population (e.g., reducing health risks of obesity) and individual benefits (reducing preventable inpatient experiences).
With this model as a context, the question for providers becomes:  should quality measures drive clinical operations or are they simply indicators of practice-level trends towards best practice?

To Boldly Go Where Almost Everyone Has Gone Before

Greg Wise, MD
Editor, Focus 
Kettering Medical Center System
Dayton, OH 

In the path of October 1 with the implementation of ICD-10, I am reminded of Elisabeth K├╝bler-Ross's famous stages of emotions in her book On Death and Dying.  I have already seen the Denial and Isolation, Anger, Bargaining and Depression expressed by many of my colleagues.  I am confident that begrudging Acceptance will eventually follow since there will be nowhere to escape.  
Obviously there is some comic relief in the midst of the maelstrom.  Going from 18,000 to 140,000 codes is bound to create considerable pain, inefficiency and frustration.  Fortunately we won't be using the vast majority.  My personal favorite is W22.02XA, "walked into lamppost, initial encounter."  As a teenager my brother and I were playing catch in front of our house, and he led me with a pass where I crashed into the corner lamppost dislocating my patella.  Two subsequent dislocations from less traumatic football injuries led to surgery.  It's been fine since then although the length of the incision would by today's standards be grounds for malpractice.  When my draft number was called during the Viet Nam War, the physician examining me took my history and looked at the scar, asking me, "Do you want to go into the Army?"  I thought this was a trick question, but I responded, "Not really, sir."  He said, "OK, I'll keep you out."  So W22.02XA, if it had existed then, might have saved my life.  Getting accepted to medical school shortly thereafter sealed the deferment. 

Ethics Committee Update

To all Members of the American College of Medical Quality:
I need more volunteers ASAP to be members of the The Ethical and Professional Policy Committee of the American College of Medical Quality.  Please look at our website and click on the link that says Policies.  This will give you a feel of what we do.

New Resources

A new continuing-education resource from the Agency for Healthcare Research and Quality (AHRQ) is now available at no cost for clinicians' continuing-education credit. The topic brief explores how low health literacy levels are related to poor health outcomes, including higher risks of death and more frequent visits to hospital emergency departments. This resource also highlights interventions that could be implemented in clinical practice to change health outcomes, such as intensive disease-management programs. Access the free topic brief and obtain continuing-education credit at no cost: 
Register Today! ACMQ's 6th National Workshop on Quality for Medical Education

American College of Medical Quality
Student and Resident Section's
2015 National Workshop on Quality for Medical Education

Since 2011, the American College of Medical Quality and its Student/Resident Section have hosted a National Workshop on Quality for Medical Education. The workshop provides health professions' faculty, students, residents, and fellows with a tailored inter-professional experience to learn how to be leaders who can successfully integrate patient safety and quality improvement into their careers. During the workshop, trainees meet with national experts who discuss important technical and leadership skills.
This year, the ACMQ Student/Resident Section has partnered with the Medical University of South Carolina in Charleston to co-sponsor MUSC's "The Art of Leadership" Conference on
Friday, October 23, 2015 from 7:30am-6:15pm, at the Charleston Marriott Hotel. 

Pricing for ACMQ Members:

$25 off for ACMQ member students, residents, and fellows
Code: ACMQ

General - $375
MUSC Alumni & Employee and CSHSMD Members - $275
Students & ACMQ member students, residents, & fellows - $50

This conference is in conjunction with the Strategic Leadership in the Face of Change Conference Thursday afternoon. Registration will give you access to both conferences.

Register Now 

Support the AJMQ!      




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