2. DISCLOSURE
Executive Director Accreditation for Cardiovascular Excellence

3. Are Random Case Reviews Necessary in Today’s Environment?

4. 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.

6. 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

7. 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

9. 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

10. WHAT SHOULD YOU DO?

12. 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

15. 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:
2ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization. JACC, 2009; 53:

16. 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

17. 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

18. 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

19. You can run, but you can not hide

20. THANK YOU!