DISCLOSURE Executive Director Accreditation for Cardiovascular Excellence
Are Random Case Reviews Necessary in Today’s Environment?
Ashland doctor convicted of performing unneeded heart procedures $845K settlement: Penn Health System resolves improper Medicare billing claim St. Joseph Health System agreed in 2014 to pay $16.5 million to settle accusations that doctors at its hospital in London performed hundreds of unnecessary heart surgeries to pad the bottom line. Ashland doctor convicted of performing unneeded heart procedures Hospital agreed in May 2014 to pay the government $40.9 million to settle claims that it doctors were performing surgeries that were not medically justified.
Why you need Reviews RISKS REWARDS Oversite from: Public opinion Government ( CMS) Healthgrades US NEWS Public opinion Reduced payments Fines/Jail time Preferred provider for: Patients Referring physicians Insurance companies ACO Enhanced Reimbursement Reduced penalties
Components of Quality program In the Lab Outside the lab Appropriate patient Updated Policies & Procedures Complete and clear documentation Safe environment Appropriately trained personnel Complete procedure reports Monitoring of outcomes Trending & Benchmarking Random case reviews M&M conferences Patient follow up
Requirements Every lab should have a Quality program that includes: Participation in a quality registry Random Peer case reviews for all operators Complication reviews for both in lab and in hospital Standardized protocols: Vascular complications Stroke Arrhythmias Tamponade Shock
WHAT SHOULD YOU DO?
Finding the Right Tools There are lots of resources Professional societies Published guidelines Online education Multiple APPS Meeting attendance Sharing “best practices” from other facilities
Why Have Angio Review? Assure indications for invasive procedures and intra- procedure decision-making conform to guidelines Permits learning from others’ routine cases, not just complication cases Independent criteria provide objective quality measures ACCF/SCAI Cath Indications1 PCI Appropriateness Criteria2 For questionable or inappropriate case selection or procedures this is the venue to discuss openly and develop collaborative action plan Non-punitive: the aim is process improvement 1A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with SCAI. Circulation, 1999; 99:2345-57 2ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization. JACC, 2009; 53:530-553
Angio Review: How To Make It Happen Designate responsible MD (CCL Director) or CCL manager, Quality Officer to select random cases for review Cases presented by a fellow if possible Cases reviewed openly, in group, with discussion Never review a case when responsible MD away Keep track of progress (e.g., appropriate indication, number of “normal coronary” cases, use of FFR) and update the group on progress
Expected Outcomes Identifies variation in practice Identifies variation in patient selection Provides a standardize process for evaluation of operators Removes politics from Quality initiatives Provides a non threatening process Assists programs in building a robust internal process Key component of an overall quality initiative
What you can do? Be a patient advocate If you see something, say something Encourage your organization to use AUC apps Participate in quality reviews
You can run, but you can not hide
THANK YOU!