AAP - quality improvement

1. AAP - quality improvement Bukur-Doczy Krisztina, M.D.

2. The goal of AAP • Protect the patients – children • Develop a database on doctors • Develop practices that will follow evidence based medicine • Develop health insurance coverage for the under priviledged

3. The structure of pediatrics • Academics • Research based positions • Specialties in tertiary centers • Private • Governmental sponsored • Hospital • Health Department

4. Private • Private practice • Hospital based • Combined • Office based

5. Who pays for the care • Private: Insurance companies • Government sponsered: Medicaid • State sponsored insurance companies • Selfpay • New method:Prometheus

6. What gets paid and what does not ? • Managed care decides how much and who will get the best premiums

7. Example: Office visit level 3 • Medicaid • Self pay • AETNA • Oxford • MVP

8. Negotiate your payment • Hire the best CEO you can afford • Large groups have leverage • Develop business model • Examples: two groups compare

9. Three drivers of health care expenditure • Cost • Access • Quality

10. Managed care model • 1990´s • Cost plus access: gatekeeper model

11. Quality care model Incentives for quality care Reason: increased number of babyboomers

12. Quality care model • The biggest barrier: present system rewards waste and does not factor in quality • Physicians need to embrace and direct changes neccessary to improve care • Physicians are best equipped to make the judgement for the best care

13. How much can be saved • 1.4 billion dollarsUS health care cost • 15-30 % by operating efficiently and improving quality • 8-9% technology • 2.5 % medical errors • 1 % waste

14. How is quality defined? • Subjective • Few evidence based studies • Incentives: 10 % bonus if you achieve quality • Measures: • Overall satisfaction • Communications • Timelines of care • Treatment received

15. Increased patient cost Example

16. Quality rating agencies National Committee for Quality Assurance • URI and antibiotic use • Strep pharyngitis and antibiotic use Bridges to Excellence • Create quality of care • Financially reward physicians

17. Quality improvement • Improvement priorities • - obesity • - patient safety • - neonatalogy • - chronic care services • ( access to care, developmental care, menatl health, oral health, medical home)

18. Quality improvement • Medical education • Patient care • Patient access • Cuomo´s doctors ranking model code to adopt principles of accuracy, transparency, and oversight

19. Under the Doctor Ranking Model Code insurers will, • Ensure that ranking of doctorś are not based solely on cost • Use estabilished national standards to measure quality and costefficiency, including measures indorsed by the NQF

20. Disclose to consumers how the program is designed and how doctor´s are ranked, and provide a process for consumers to register complains about the system • Discolse to physicians how ranking are designed, and provide a process to appeal incorrect rankings • Nominate and pay for the rating examiner who will oversee compliance with all aspects of the new rating model

21. Protects consumers • Sets the standard for all insurers to meet

22. AAP main branch and chapters • SOAPM – section of practice management • SERMO