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Quality
and Safety
I discussed the importance of all institutions whether
for profit or non-for-profit maintaining high quality
standards and safety standards for cardiovascular care.
I specifically outlined the importance of the use of the
national cardiovascular data registry (ACC NCDR) in all
cardiovascular hospitals in the state. A number of
Senators and Representatives were particularly
interested in the importance of maintaining quality and
some objective measure of quality from an outside
organization.
Lastly, solutions that
were discussed included:
· Impose statewide quality in patient safety standards
throughout all hospital institutions.
· Require specialty hospitals to accept Medicare,
Medicaid, and indigent patients.
· Require full emergency room services at all hospitals
in the State of Indiana (including specialty hospitals).
A defined relationship between specialty hospitals and
general hospitals must be established in order to
facilitate safe transfer.
· Avoid the certificate of need program since it would
not have its intended effect since in central Indiana
the "horse is out of the barn."
Importantly, this is a particularly cumbersome program
which would require enormous state resources to provide
oversight and be very costly.
· The Ambulatory Surgical Centers should be
disconnected from the specialty hospital discussion
since this is a totally separate issue. These are
highly cost effective and efficient locations for the
delivery of cardiovascular care.
Overall, it was a
particularly positive interaction. I stressed the
importance of using a national registry such as ACC NCDR
as an objective measure of quality from an external
organization as opposed to the state relying on internal
generation of quality measures.
ACC
Medical Directors Institute: October 15-17, 2003
(Dallas, Texas)
I was invited to this activity since I
sit on the ACC Disease and Management Committee, which
is an attempt to bridge the use of ACC practice
guidelines with implementation of these instruments by
the disease management companies. Many managed
care organizations use these management companies to
help manage their cardiovascular population.
This conference was held
in order to attempt to have a collaborative discussion
between the medical directors of major health plans in
the United States with ACC leadership. There were
33 medical directors present from various health plans
throughout the country including Anthem, as well as 30
physician leaders from the ACC and staff. The
following items were discussed: the current environment
of cardiology in the healthcare continuum, quality
measurement, paying for quality and a technology
assessment.
The most important aspect of the conference was that an
entire half day was provided for focus groups to discuss
various issues and come up with solutions. Half of
each group were health plan medical directors and
the other half were ACC members.
We talked about what
tools and processes can be developed to ensure access to
imaging services based on analysis of quality data.
We also talked about new medical technology, measuring
quality, paying for quality and disease management.
In general, the
conference was particularly helpful. There were
some general topics to discuss regarding the best method
to enhance working relations between health plan medical
directors and cardiovascular specialists in order to
build trust and improve delivery of quality care.
As a result of this
conference, The Medical Director Institute will continue
on an annual basis in order to develop to a greater
degree the relationship between health plan medical
directors and cardiovascular specialists. Mechanisms and
dialogue at both the national and local level will be
developed. Cardiovascular specialists should volunteer
to participate in health plan panels to provide advice.
Finally, there should be serious bilateral commitment to
control cost and enhance trust, as well as emulate a
sense of "fair trade" between our
organizations. Share
your comments.
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