Julie L. Hopkins, MA, MBAVice President, Hospital & CME Programs

Institute for Medical Quality

QICMERelationship:

Informal, Not Strategic

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Professional Accountability◦ Maintenance of Certification (MOC)◦ Maintenance of Licensure (MOL)

Public Accountability◦ 2008 Senator Grassley, (US Senate Finance Committee)

questions medical societies about corporate support from pharmaceutical and medical device companies

◦ Effective December 4, 2007 under Stark Law II: CME becomes a perk! Intent: To ensure no wrongdoing by nature of the

relationship, e.g., enticing physicians to refer more Medicare/ Medicaid patients to a hospital by giving them lots of perks

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Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Supportsm

PHARMA & medical device companies ◦ Reduced and restructured CME support◦ Moved from Marketing to grants/foundations

2011 AMA passes CEJA recommendation further restrict commercial interests and CME

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ACCME 2006 Elements and Criteria AMA 2010 changes to PRA Category 1 Credits

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Links between quality & reimbursement start to matter more

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Meaningful Use – $40B HIT and EHR stimulus Value-Based Purchasing – Quality and HCAHPS

◦ Move from pay for data to pay for performance◦ Processes and outcome transparency◦ Data to coordinate care ◦ Readmission Reduction Program◦ Patient-Centered Medical Homes◦ IHI + AHRQ: Value = Quality/Cost◦ Data to reduce costs and maintain margin◦ Bundled Payments◦ Accountable Care Organizations (ACOs)

Why? Because you can: 1. Have the most influence on improving

patient care at the point it is delivered2. Focus on what needs improvement3. Measure impact/results and determine

what worked/didn’t work4. ?5. ?

1. National Quality Statistics & Goals2. Organizational Quality Goals/Performance3. Best Practices

The Centers for Disease Control and Prevention (CDC) estimates annually:◦ At least 1.7 million healthcare-associated

infections occur leading to 99,000 deaths◦ 1in every 20 hospitalized patients in US

acquires a healthcare-associated infection◦ Of these, central intravenous line associated

blood-stream infections (CLABSIs) are most deadly: mortality rate of 12-25%

How do national statistics or goals impact local quality and CME?

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2006 AHRQ funded Michigan Keystone Intensive Care Unit Project (Keystone Project)

Partnership: Johns Hopkins University & Michigan Health and Hospital Association

Results:◦ Reduced rate of CLABSIs by 2/3 in 3 months◦ In18 months saved more >1,500 lives and

nearly $200 million◦ 2011: improvement Sustained

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2011: Awards $34 Million To Expand Fight

Projects: SPREAD use of Comprehensive Unit-based Safety Program (CUSP) modules

Since 2008: AHRQ has promoted nationwide adoption of CUSP to reduce CLABSIs

New modules target 3 additional infections: ◦ Catheter-associated urinary tract infections◦ Surgical site infections◦ Ventilator-associated pneumonia

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Translate national statistics and goals into local CME and Quality Initiatives

Education – a key component but not only component to achieve results

Education delivered at local level, where it makes a difference

Quality/Patient Safety is measured locally, but compared to national or regional results

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Does your organization measure National Quality Goals because of public awareness ora desire to improve performance?

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What are the quality/patient safety goals or targets for your: ◦ Hospital?◦ Department/Divisions?◦ Clinics◦ Medical Groups?

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What gap must be closed to achieve the goal?

Example: Improve percentage of patients evaluated for osteoporosis

Target: 85% Current Performance: 50%

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What causes the gap: e.g., ◦Systems◦Education◦Resources

Example: What are underlying causes for patients not being evaluated for osteoporosis

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Are there educational needs (knowledge/competency/skill) that, if met, will close or help to close the gap/achieve the goals?

Example: Can any of the underlying causes for patients not being evaluated for osteoporosis be addressed through CME?

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Guidelines from specialty organizations Changes in techniques, processes or

decisions based on evidence emerging from research or studies (e.g., Keystone Project)

New technology that reduces risk to patient

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What relevant best practices are: o Emerging in the services your organization

provides?o Known but have not been widely adopted in

your organization?

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Recent studies show lower complication and readmission rates

Attributed to wide adoption of best practices

How does your organization compare? How can CME help? Example, specialty hospital conducting CME

for medical staff at rural referral hospitals

How do you gain adoption…SPREAD…those best practices across a specialty/organization?

Can CME play a role in expediting adoption of a best practice among your peers in your organization?

Are there quality measures or goals related to this best practice that would benefit from its wide-spread adoption?

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How do you know what worked

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QI/PI data source used to identify gaps/learning needs is used to determine effectiveness of CME

Take credit, even when achievement was multifaceted

Document analysis, decisions, not just data

For all you do, everyday, to make life better for so many.

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