Quality First

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 ApproachQCAREPeer 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

• QCARE

• 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

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 ACCs National Cardiovasclar Data
  Registry (NCDRTM), the nations 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.