AAP%20-%20quality%20improvement

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AAP - quality improvement

• Bukur-Doczy Krisztina, M.D.

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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

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The structure of pediatrics

• Academics
• Research based positions
• Specialties in tertiary centers
• Private
• Governmental sponsored
• Hospital
• Health Department

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Private

• Private practice
• Hospital based
• Combined
• Office based

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Who pays for the care

• Private Insurance companies
• Government sponsered Medicaid
• State sponsored insurance companies
• Selfpay
• New method Prometheus

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What gets paid and what does not ?

• Managed care decides how much and who will get
  the best premiums

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Example Office visit level 3

• Medicaid
• Self pay
• AETNA
• Oxford
• MVP

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Negotiate your payment

• Hire the best CEO you can afford
• Large groups have leverage
• Develop business model
• Examples two groups compare

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Three drivers of health care expenditure

• Cost
• Access
• Quality

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Managed care model

• 1990s
• Cost plus access gatekeeper model

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Quality care model

• Incentives for quality care
• Reason increased number of babyboomers

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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

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How much can be saved

• 1.4 billion dollars US health care cost
• 15-30 by operating efficiently and improving
  quality
• 8-9 technology
• 2.5 medical errors
• 1 waste

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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

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Increased patient cost

• Example

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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

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Quality improvement

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

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Quality improvement

• Medical education
• Patient care
• Patient access
• Cuomos doctors ranking model code to adopt
  principles of accuracy, transparency, and
  oversight

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Under the Doctor Ranking Model Code insurers
will,

• Ensure that ranking of doctors are not based
  solely on cost
• Use estabilished national standards to measure
  quality and costefficiency, including measures
  indorsed by the NQF

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• Disclose to consumers how the program is designed
  and how doctors 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

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

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