Quality F irst Physician Accountability in Health System Reform

Health System Reform is Essential and Imminent Are We Ready?

Three Fundamental Elements of Health System Reform: Quality Access Cost * Note: Quality Comes First!

Cardiovascular Trends: Cardiovascular disease continues to be #1 killer in United States.Cardiovascular disease continues to be #1 killer in United States. Forty-three percent of all Medicare dollars goes to cardiovascular related treatmentForty-three percent of all Medicare dollars goes to cardiovascular related treatment Aging population is placing greater demand on cardiovascular servicesAging population is placing greater demand on cardiovascular services Looming shortage of cardiovascular specialistsLooming shortage of cardiovascular specialists

Environmental Trends: Congress/Payers increasingly looking to reduce costsCongress/Payers increasingly looking to reduce costs Congress directing CMS to oversee performance and qualityCongress directing CMS to oversee performance and quality Rapidly developing new technologiesRapidly developing new technologies Health Care a major topic among candidates running for elected office in 2008Health Care a major topic among candidates running for elected office in 2008

Health System Reform Everybody must bring something to the tableEverybody must bring something to the table –Government –Payers –Hospitals –Patients –Business –Physicians and health care providers

Currently Physicians and the Health Professions are NOT at the Table Single Payer Reform Single Payer Reform Employer Mandates Employer Mandates Individual Mandates Individual Mandates Voluntary Approaches Voluntary Approaches Reimbursement vs. Access Reimbursement vs. Access

So … Can health care professionals, such as the ACC, be self-regulating entities? Can health care professionals, such as the ACC, be self-regulating entities? Can physicians overcome conflicts of self interest to do this effectively? Can physicians overcome conflicts of self interest to do this effectively? Is government going to take over quality measurement regardless of what the profession does? Is government going to take over quality measurement regardless of what the profession does?

What Should Physicians Bring to the Table? Individual and collective professional responsibility for quality and valueIndividual and collective professional responsibility for quality and value Care that isCare that is –Patient-centered –Evidence-based –Cost-effective –Value vs. volume –Ethical

Peer Review on a Macro Level The ACC Approach: QCARE Peer Review on a Macro Level

QCARE An end-to-end, systems approach to continuous quality improvement that translates science into practiceAn end-to-end, systems approach to continuous quality improvement that translates science into practice Results in care that is in line with IOM goals: Safe, Effective, Patient-Centered, Timely, Efficient and EquitableResults in care that is in line with IOM goals: Safe, Effective, Patient-Centered, Timely, Efficient and Equitable Quality Care through Continuous Application of Standards, Reporting and Education

QCARE Continuous review of new scienceContinuous review of new science Evidence-based guidelines and standardsEvidence-based guidelines and standards Comprehensive educationComprehensive education Appropriateness CriteriaAppropriateness Criteria Data reporting and collection through registries (NCDR)Data reporting and collection through registries (NCDR) Specific quality initiatives (D2B)Specific quality initiatives (D2B) Adoption and appropriate use of new technologyAdoption and appropriate use of new technology Evaluation through self-assessment tools, performance testing and longitudinal studiesEvaluation through self-assessment tools, performance testing and longitudinal studies

QCARE Q Patient Centered Care

QCARE Today Continuing to develop and update evidence-based guidelines and national performance measurement and data standards for both inpatient and outpatient care. Continuing to develop appropriateness criteria to help determine when and how often to perform diagnostic imaging exams. (To date: SPECT MPI, CCT, CMR and TTE/TEE) Expanding the ACC’s National Cardiovasclar Data Registry (NCDR TM ), the nation’s premiere quality measurement program for cardiac and vascular facilities and the gold standard for cardiac data collection, reporting and benchmarking. Providing evaluation opportunities through self-assessment tools, performance testing and longitudinal studiesProviding evaluation opportunities through self-assessment tools, performance testing and longitudinal studies

QCARE Today (Cont.) Developing programs like D2B: An Alliance for Quality that put guidelines into practice by providing physicians with tools and strategies to improve quality. Continuing to work with Congress and the Centers for Medicare and Medicaid Services (CMS) to develop quality improvement programs that benefit both patients and practices. Supporting federal efforts to speed the adoption off health information technology (HIT) – a critical component of measuring quality, performance and efficiency.

How Do We Take QCARE To The Next Level? Turbocharged Guidelines and Clinical Consensus DocumentsTurbocharged Guidelines and Clinical Consensus Documents Ambulatory Data CollectionAmbulatory Data Collection EHR Adoption With Embedded GLs and Decision-Support SoftwareEHR Adoption With Embedded GLs and Decision-Support Software Financing Comprehensive QualityFinancing Comprehensive Quality Improvement Improvement

What Are the Barriers? Suspicion about our ability to self- regulateSuspicion about our ability to self- regulate –Conflicts –Self serving –Industry partnerships Individual physician commitmentIndividual physician commitment Significant resources needed to go from guidelines to practiceSignificant resources needed to go from guidelines to practice Time may be running outTime may be running out

Our Job is NOT Done! To Ensure Quality Comes First We Must: Continue to lead in the quality arena and move beyond process measures to focus on outcomes. Imbed quality in everything we do. Honor our individual and collective responsibility to provide care that is patient- centered, evidence-based and cost- effective.