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Quality F irst

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:.

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Quality F irst

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  1. Quality First Physician Accountability in Health System Reform

  2. Health System Reform is Essential and ImminentAre We Ready?

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

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

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

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

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

  8. So … Can health care professionals, such as the ACC, be self-regulating entities? 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?

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

  10. The ACC Approach:QCAREPeer Review on a Macro Level

  11. QCARE Quality Care through Continuous Application of Standards, Reporting and Education • An 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 Equitable

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

  13. QCARE

  14. 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 (NCDRTM), 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 studies

  15. 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.

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

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

  18. 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.

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