PSTF Monitors Quality

The Hospitalist. 2006 December;2006(12):

December 1, 2006 | The Hospitalist

Quality Care Liaisons

In addition to fostering liaisons with organizations like PCPI and NQF, the PSTF has discussed the importance of exploring relationships with other groups, including CMS, the American College of Physicians (ACP), the Ambulatory Quality Care Alliance (AQA), and others engaged in the quality care arena.

In late spring 2006 several SHM members and staff met with CMS to discuss its PVRP in relation to hospitalists. While SHM has endorsed the PVRP, recommending that hospitalists register their intent to report and begin reporting on relevant performance measures to the extent practicable, it is clear that the 16 measures used in the PVRP have limited relevance for hospitalists because most measures used for internal medicine deal with services provided in the ambulatory setting.

Specifically, only two of the 16 measures apply to services billed by hospitalists and those only on a limited basis: aspirin on arrival for myocardial infarction and beta-blocker on arrival for MI have G-codes that can be used with the evaluation and management codes appropriate for hospitalists. In its follow-up letter to CMS staff thanking them for their time, SHM leadership also included recommendations that would expand the current number of PVRP measures that hospitalists could report on from two measures to seven.

SHM has also shared the above quality and performance improvement agenda with the staff of the ACP as well as their quality subcommittee, who have found it to be “well-reasoned and straightforward.” We anticipate having more in-depth discussions with the ACP as our quality agenda evolves.

In August, the Ambulatory Care Quality Alliance (AQA) and the Hospital Quality Alliance (HQA) joined forces to form a Quality Steering Committee in order to better coordinate the promotion of quality measurement, transparency, and improvement in care across hospital and ambulatory care settings. The PSTF is currently pursuing participation in one of the new AQA/HQA workgroups created by the steering committee, which would focus on harmonization of measures across settings.

SHM staff have also reached out to the Society of Critical Care Medicine, the Joint Commission on Accreditation of Healthcare Organizations, and the American Hospital Association to ascertain what these groups are doing in terms of quality and measure development, as well as to see how to align our efforts more closely.

In its work with all of these groups, the task force endeavors to ensure the development of performance measures that more accurately reflect services provided by hospitalists.

2007 Goals

The HQPS has developed a mechanism whereby they review measures proposed by a variety of organizations in order to evaluate which measures are relevant to individual clinicians as compared with institutional measures. It is PSTF’s goal (in conjunction with the HQPS, the PPC, and others) to recommend to the SHM board of directors which physician-level disease-specific measures are relevant to individual hospitalists and to identify where the gaps are. It hopes then to influence the scope of development of care coordination and other hospital-level measures that are in the pipeline, whether working through groups like the PCPI by taking the lead on an expert workgroup, by using the NQF consensus-building process, or by forming other key partnerships with groups like those noted above. It is likely that this work will be accomplished by some combination of these strategies.

Stay tuned for next month’s “SHM Behind the Scenes” by SHM Senior Vice President Joe Miller.

Epstein is the senior advisor for Standards and Compliance at SHM.

SHM Chapter Updates

Chicago

On September 6, the Chicago chapter held a meeting at the Carnivale Restaurant and elected new officers. Tarek Karaman, MD, who will serve as president, announced plans for the next year and thanked the existing officers. This was followed by a lecture on MRSA infections. The evening was sponsored by Cubist Pharmaceuticals.

Pacific Northwest

The Pacific Northwest Chapter of SHM met Wednesday, September 20, at the Columbia Tower in Seattle. The chapter’s meeting was an open forum panel discussion in which attendees submitted questions. The panel consisted of representatives from four different hospital medicine groups. More than 40 attendees represented six HMGs. The Pacific Northwest Chapter’s September event was supported by Ortho-McNeil and Schering-Plough.

San Diego

San Diego’s most recent chapter dinner was held on September 14 at Roy’s in La Jolla. A presentation by Alpesh Amin, MD, of the University of California at Irvine, entitled “The Burden of MRSA in the Hospital Setting,” stimulated a lot of discussion and debate regarding the rapid expansion of MRSA in the U.S. and possible ways to control and contain it. Continuing Medical Education credit was provided to all attendees by RXperience through the University of Kentucky (Lexington).

Atlanta

The quarterly meeting of the Atlanta SHM Chapter took place on September 20 at Maggiano's Little Italy Restaurant in Buckhead. The keynote speaker was Michael Heisler, MD, MPH, associate professor of medicine, Emory University School of Medicine, and medical director, Hospital Medicine Service, Emory Eastside Medical Center, Atlanta. Attendees found Dr. Heisler's presentation, “Medical Emergency Team/Rapid Response Team: Pre-empted Strike: Saving Lives, One at a Time” concise, evidence-based, and tailored to everyday practice.

The keynote presentation was followed by a panel discussion. The panel included Martin Austin, MD, medical director, Hospital Medicine Service, Gwinnett Medical Center, Atlanta, and Cathy Wood, RN, director, Medical and Surgical Nursing Services, Emory Healthcare, Atlanta. Val Apokov, MD, medical director, Hospital Medicine Service, Emory Crawford Long Hospital, Atlanta, provided the introduction and discussion moderation.

Attendees represented many major medical centers in the metropolitan Atlanta area, including Emory Eastside Medical Center, Emory University Hospital, Emory Crawford Long Hospital, Children's Healthcare of Atlanta, Piedmont Hospital, Gwinnett Medical Center, and DeKalb Medical Center. The meeting was supported by Sanofi-Aventis.