louisiana quality insider newsletter

8/9/2019 Louisiana Quality Insider Newsletter

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InsiderQuality

Issue 3| Volume 15 | 2010

Dr. Trent James, Assistant Medical Directorand Scott Flowers, CMS Project Director,attended the American Health Quality As-sociations Capitol Hill Week in July of 2010.

AHQA is the trade association for Medicare

quality improvement organizations across thecountry.

Louisiana congressional members werepresented with information that highlightedthe 2010 Louisiana Medicare Quality Award

Winners. Congressman Cassidywas veryinterested in how the Surgical Care Improve-ment Performance (SCIP) program is improv-ing surgical care in Louisiana hospitals. Con-gressmen Gao and Scalise were presentedinformation about nursing homes that are

quality leaders in their region and were veryinterested in eQHealths New Orleans regionspecial projects to improve care for African-

American diabetes patients.

Also important in our discussions was howeQHealth and the QIOs are playing a pivotalrole in the Affordable Care Act quality im-provement implementation.

eQHealth Solutions work fighting Medicarefraud through the Senior Medicare Patrol vol-unteeres in Louisiana was another hot topic(see SMP story at right). Watch for SeniorMedicare Patrol leadership and information atCongressional town hall meetings throughoutthe state!

Do you have a story to share?

If you have a story you would like toshare with Quality Insiderreaders or asuggestion for a story, we would liketo hear from you. Please contact LisaStansburyat [email protected] orphone (225) 248-7023.

Louisiana congressional delegation eager for

healthcare quality updates from home

A Publication of

THE MEDICARE QIO FOR LOUISIANA

Taking more time withpatients . . . . . . . . . . . . . . . . 2

Resilience: The lessonslearned from disaster . . . . . 3

Physicians awarded for preven-tive care improvements . . . . 5

Visiting with Louisiana Rep. Bill Cassidy (center) are

eQHealths Dr. Trent James (left) and Scott Flowers

(right)

Dr. Trent James (left) and Scott Flowers (right) visit

Louisiana Rep. Steve Scalise during Capitol Hill Week.

Save the Date! Friday, April 29, 2011

Please mark your calendar for Friday, April 29, 2011 and join us in BatonRouge for the Louisiana Medicare Quality Summit & Awards. And dontforget to check our Summit fan page on Facebook to get Summit 2011updates and see highlights from last years event.

2011

BUSTED! SMP helps

OIG find scammer

On Friday, July 16, HEAT MedicareFraud Strike Forces in five states in-dicted 93 healthcare providers accusedof scamming $251 million from theMedicare system. Dr. Dahlia Kirk-patrickwas one of four physicians in-dicted in what has been called the larg-est bust in Medicare history. Louisiana

Senior Medicare Patrol (a programsponsored by eQHealth and fundedin part through the Administration on

Aging), provided information to theOffice of the Inspector General whichhelped secure the indictment.

SMP learned ofDr. Kirkpatrickfrom our partners at the Aging andDisability Resource Center in Houma.The doctor was prescribing unneces-sary medical equipment for beneficia-ries who were not even her patients.

Interestingly, Dr. Kirkpatrickwasalready under investigation for possiblefraud in conjunction with a companyin Prairieville. We believe LousianaSMPs reporting of a secondaryMedicare fraud scheme was valuableinformation for the Strike Force.

To learn more about Louisiana SMP,how to detect Medicare fraud andhow to become a volunteer, please visit

www.stopmedicarefraudla.org.


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By: Brandon CampoCommunications CoordinatoreQHealth Solutions

Practicing medicine isnt only aboutpushing pills. Most importantly its abouttaking time to educate the patients so they

understand their disease and hopefullytake better care of themselves, said Dr.

Andriette Fitch, a Family Practitioner inPlaquemine recently identified as a bestpractice physician participating in theEvery Diabetic Counts(EDC) program. EDCis a project funded by theCenters for Medicare andMedicaid Services and isdesigned to reduce healthcare disparities within the

African-American Medi-care diabetic population.

Based on data collectedfrom July 2008 to June 2009, Dr. Fitchspatient population with diabetes surpassedthe percentage goals set by CMS for

African-American patients with diabetesreceiving Hemoglobin A1C blood tests,retinal eye exams and lipid testing. Eighty-five percent ofFitchs patients receivedHemoglobin A1C blood tests, whichreflect a patients average blood sugar levelfor a three month period. In addition, 77percent of her patients kept their appoint-ments for retinal eye exams which helpprevent blindness by detecting and treatingproblems early. Ninety-two percent alsoreceived a lipid test.

In todays medical setting, Fitch said doc-tors are strapped for time and many believethat spending more time with patients willreduce the number of patients that are ableto be seen. Its a notion she wants dis-missed. I really havent seen a decrease inthe amount of patients I treat, she said.

In fact, Fitch believes giving extra timeand attention to patients is how she hasachieved such success with her patients.If you spend a little extra time with yourpatients, they begin to understand thedisease and take ownership of their health.My patients now know where I expect alltheir levels to be and if they need to fastbefore an appointment. All a patient really

wants is a little time with their doctor to

ask questions and to understand thedisease, she said.

Fitch said she gives the newly-diagnosed patient with diabetes anabundance of educational materials.Though Fitch admits the amount

of the materials is overwhelming,she urges her patients to keep thepamphlets and flyers in the livingroom or bathroom, any place theycan thumb through the materials a

few minutes at a time.

New patients are alsoinstructed to visit Fitchfor regular checkupsevery two weeks untilshe determines that theyunderstand what diabe-

tes is and what it does tothe body. During thesevisits, Fitch takes extra

time to explain the meaning of patientstest results, such as the Hemoglobin A1C,

which Fitch administers to the patient afterbeing diagnosed with diabetes. Fitch saidshe attributes her med tech background asa reason she places an em-phasis on a patients blood

work.

The patient may not

know exactly how toexplain the A1C test result,but they will understand

what number they shouldbe at and why its im-portant, she said. Fitchuses the Hemoglobin A1C test results todetermine the best treatment plan for thepatient, as well as a motivator. If thenumber is low, then a change in diet may

just be required, but if its high, multiplemedications will probably have to be givensince organ damage may be occurring. My

goal is to have that number around six orseven, and each of my patients know this,she said.

Other tests important to patients with dia-betes, such as the annual retinal eye exam,are done out the office: a dangerous lapsein the care continuum. Fitch instructs anoffice staff member to make these appoint-ments for her patients with diabetes beforethey leave her office.

The patient has the choice to cancel, butthe initial appointment is made for them,Fitch points out. I learned early on that ifyou dont make the first appointment, thepatient will come back with every excuse inthe world why they didnt go.

Fitch doesnt claim to holdany secrets about practicingmedicine. She simply followsone golden rule: Treat every

patient like theyre a memberof the family.

I was always trained totake care of my patients asif they were my family, and

youll never go wrong, Fitch said. Ifthat patient with diabetes is my mother ormy grandmother, I wouldnt want anyonedoing any less to them than I would do toanyone elses mother or father. I take thatpersonally; you cant teach passion.

For more information on the Every Dia-betic Counts program, visit our website at:http://louisianaqio.eqhs.org/edc.htm

Taking more time with patients gives physician greater influencePatients participate in healthy behaviors more often after extra TLC from their doctor

If you spend a littleextra time with yourpatients, they beginto understand thedisease and take

ownership of theirhealth.

I was always trainedto take care of my pa-tients as if they were

my family, and youllnever go wrong.

- Andriette Fitch, MD

Dr. Andriette Fitch displays diabetes educational materialsprovided for her patients.


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By: Wilma Marler, MSA, QMHPQuality Improvement SpecialisteQHealth Solutions

Think back to 2005, the year of hurricanes,and fast forward to April 2010, the year ofthe oil spill. These are disasters of a different

kind, but what has it done to us? We arenow in hurricane season, and we are alreadybeing bombarded with the word disaster.

The Southwest Louisiana Culture Changeand Workforce Coalition members werereminded of the word, the impact and howto deal with our reactions. Without realizingit, we are reliving the stress and stressreactions of 2005, just with a different name.

Dr. Susan Wehry, MD, Clinical AssociateProfessor, College of Medicine at University

of Vermont, was the guest speaker at theJune 25th meeting ofthe coalition held atthe Calcasieu Councilon Aging office inLake Charles. In apresentation entitled,PsychologicalPreparedness DuringHurricane Season, Dr.

Wehryreminded thecoalition of the lessons learned in the twoyears that followed the 2005 hurricanes

when we convened special focus workgroupsin New Orleans and Lake Charles. We

were reminded of the coping skills welearned and how stress had changed ourlives. But the dramatic effect stress canhave was emphasized by what Susan Wehryexperienced that very morning at breakfast.Having completed her morning workout,she thought she was prepared for the day.

Yet, in just three short minutes, with atelevision newscast in the background, shebegan to feel anxious about the day. She

described to the group her feelings afterhearing the different combinations of thewords disaster in the gulf, gulf disasterand just disaster. Her body returned tothe state of fight or flight syndrome that

we felt during the hurricanes called Katrina,Rita, Gustav and Ike.

Dr. Wehrynoted we are set up for the stressfeelings just with the media we listen to everyday. What can be experienced is anxiety,

nervousness,an increasein bloodpressure andother physicalreactions thatresemble the

feelings of 2005.The cautionfor all of us isto recognizethe media isplaying to ourfears alreadybecause of theoil disaster.

We haveproven weare resilient, she stated, and pointed out

the positive character attributes we havedeveloped because we notonly survived, but cameback. Those characteristicsof confidence, competenceand optimism will now becalled upon because we arealready at a heightened sinceof disaster due to the Apriloil well explosion.

What we can do is take the lesson Dr. Wehryhad for us that day. She shared some verysimple tips to immediately begin using toretrain our brains, to see the glass as half-fullrather than half-empty. The most importantlesson of the day was to begin dealing withthe stress by de-stressing. Because, if we donot deal with it, we become vulnerable to itseffects.

Dr. Wehryfinished the day with wonderfulstress relief exercises. Many of theseexercises can be done in public, such asdeep breathing, inhaling and exhaling and

recitation of your mantra. She demonstratedand had the audience participate in sighrelief, nostril breathing and good bellylaughing.

We all have a choice of how we de-stressrather than distress, and that was Dr.

Wehrys very important message to thisgroup - a support group of sorts borne of thehurricanes of 2005.

If you would like resource materials on thistopic that can help reduce stress for yourstaff, please contact eQHealth Solutions at(225) 926-6353 or visit our website (http://louisianaqio.eqhs.org) for free information.Take steps now as we enter the height ofhurricane season. Prepare your staff to avoidstress and make them resilient for whateverlies ahead.

Resilience: The lessons learned from disaster

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Here are some simple

stress-reducing tips from

Dr. Susan Wehry:

1) Limit your exposure to the news

it can be a drug

2) Build up the brain have a daily

mantra

Develop problem-solving skills

Practice flexibility

Approach things as fun

3) Determine your strategy ahead of

time

4) Nurture your personal resilience

that is, put on your oxygenmask first, before you try to help

others

Recognize your limitsTake care of your health

Have a light heart preserve yoursense of humor

Acknowledge your resilience, andput it in place, where you are now

We have proven weare resilient - we notonly survived, but(we) came back.

- Dr. Susan Wehry


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Dear Quality Improvement Colleagues,

A recent issue of the Journal of the American Medical Association (JAMA) included anarticle on research that found a poor correlation between hospital performance on individualSurgical Care Improvement Project(SCIP) process measures for infection prevention andactual patient infection rates. However, analysis showed a statistically significant correla-

tion between lower infection rates and a composite measure that included ALL of the SCIPinfection measures.

The authors concluded that public reporting of the individual SCIP process measures onthe Hospital Compare website do not fulfill their stated purpose of pointing consum-ers toward high-quality hospitals. Their primary criticism is that Hospital Compare postshospital-level reports based on the individual measures and these did not predict patientoutcomes. Composites are not currently posted to Hospital Compare.

More information about the article and a related editorial, including a link to JAMA, isprovided in the Additional notes about SCIP at right.

We wanted to make you aware of this JAMA article because you or your medical staff mayhave questions about it. It concludes that a composite of all the SCIP infection measures is

a good predictor of hospital infections and thus can provide useful information to patients.The study did not question the validity of the clinical standards on which the individualSCIP infection measures are based, but did find that individual measures do not correlate toinfection rates and thus are less helpful guides for patient decision-making.

We want to assure you that the SCIP project continues to be a high priority for both CMSand our QIO, and we want it to remain one for your hospital as well.

The authors conclusions support the importance of reaching your improvement goals forall SCIP measures; they showed that a composite measure using all of the SCIP infectionmeasures had a statistically significant correlation with lower infection rates.

Hospital-acquired infections remain the cause of extended hospitalizations and death forthousands of patients nationwide every year. They merit every hospitals continued attention

and effort.Active participation in the SCIP initiative yields results for your hospital. With technicalassistance from their QIO, thousands of other hospitals have improved performance onthe SCIP Inf-1 measure (giving antibiotics within 60 minutes of the first incision) from anational rate of 56% in 2001 to well above 90% today.

Continued participation in SCIP builds your hospitals capacity to improve its overall clini-cal performance. For example, addressing SCIP Inf-1 (giving antibiotics within 60 minutesof the first incision) requires developing consistent communication and teamwork betweenpre-operative staff, OR staff, pharmacy staff and the anesthesiologist; these skills developyour workforce and can travel with them to other areas of the facility.

We remain focused on supporting your success up to the conclusion of the current scope of

work in July 2011. If you have or receive further questions, please contact me immediatelyso I can get you answers.

Sincerely,

Trenton J. James, II, MD Samuel A. Leonard, MD, MBA Associate Medical Director Medical Director for Utilization [email protected] [email protected]

A clarification on recent JAMA article from eQHealth

Medical directors weigh in Additional notes about SCIP

To develop the SCIP measures, CMSused a considered, evidence-basedapproach that employed a varietyof evidence-based sourcesratherthan this one simple studyto makeinferences about the best ways to

deliver surgical care and to report onits safety. They are consistent withbest practice guidelines from profes-sional organizations that include the

American College of Cardiology, theAmerican College of Obstetrics andGynecology, American Surgical Asso-ciation, and the American College ofChest Physicians.

SCIP measures have gone througha rigorous review and endorse-ment process by a number of expertgroups. The National Quality Forumhas endorsed all of the measuresthrough a national consensus processthat considers the viewpoints ofmultiple healthcare stakeholders anddetermines that measures are meth-odologically sound for collection andpublic dissemination.

As the authors note, there are manyprocesses of care, patient variablesand surgeon-specific variables thatinfluence surgical outcomes andthat are not measured (nor would it

be feasible to measure all of them).This does not mean, however, thathospitals and their medical staffshould fail to adopt and consistentlyemploy processes of care that havebeen proven to reduce the risk ofinfections and other surgical compli-cations.

Background on the letter at left:Stulberg JJ, et al. Adherence toSurgical Care Improvement Projectmeasures and the association with

postoperative infections JAMA.2010;303(24):2479-2485.

Table of contents with links at:http://jama.amaassn.org/content/vol303/issue24/index.dtl?etocIf you do not have a subscription,you can read the abstract or purchasesingle-article access.


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Physicians at Baton Rouge GeneralMedical Center - Mid City were recentlypresented with plaques by eQHealth Solu-tions quality improvements specialists.The plaques were presented to physiciansparticipating in the Core Prevention proj-

ect, a part of eQHealths current contractwith CMS.

The focus of the project is to assistphysicians who have electronic healthrecord systems in improving work flows,maximizing efficiency of their systems,and improving preventive care throughthe use of EHR. These goals are accom-plished in part by:

Tracking of preventive care givento a patient

Clinical reminders generated at thepoint of care

Tracking if tests and immuniza-tions are given

Generating reports of patients notreceiving tests and immunizations

Population performance measure-ment

The Core Prevention project not only pre-pares and positions physicians to produceexcellent clinical outcomes but also helpsphysicians prepare to meet future incen-

tive requirements such as meaningfuluse and the Physician Quality ReportingInitiative (PQRI).

The Core Prevention project measurespreventive care in four areas: flu andpneumonia immunization, mammogra-phy and colorectal screening. The month-ly and quarterly measurements to date forparticipating physicians and clinics have

shown consistent improvement with fourquarters of reporting to go.

Physicians awarded for preventive care improvements achieved though EHRPreparing for future Medicare incentive requirements

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Need a speaker for your next meeting?

eQHealth Solutions qual-

ity improvement experts areavailable to speak on the mostimportant health care topicsof the day. From reducingreadmissions to implement-ing electronic health records,eQHealth Solutions is yourresource for interesting speak-ers to present at organiza-tion meetings, conferencesand board retreats.

Find more information aboutspeakers and topics at:http://louisianaqio.eqhs.org/speakersbureau.htm

eQHealth is a physician-based organization,

and physician involvement is essential to oursuccess. Physicians participate in our qualityimprovement efforts as clinical leaders, educatorsand committee members. Peer review of theutilization of services, quality of care, correctnessof DRG assignment and EMTALA are also ourresponsibility through our CMS contract.

We invite all Louisiana physicians to becomemembers of our Quality Improvement Organiza-tion. Becoming a QIO physician member putsyou under no obligation and membership is free.

Benefits of membership are many, including:

Free consultations, materials and information pertinent to yourclinical quality improvement efforts

Recognition for being a leader committed to health care qualityand the ability to foster positive change

A conduit for voicing your opinions regarding todays healthcare policies

To join us, simply complete the member form on the next page and faxto our toll free number (888-204-0327).

Why become a physician member of our QIO?

Pictured below (l to r) are: Louis Minsky, MD, Tina Wells, MD, Diana Norton,

eQHealth, Yolanda Spooner, MD, Donnie Batie, MD and James Taylor, MD

Pictured above are Diana Norton,eQHealth Quality Improvement

Specialist (left) and Michael

Howard, MD


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Telephone: (225) 926-6353 Fax: (225) 925-0342

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Quality Insider is distributed quarterly to over 10,000

physicians, hospitals, nursing homes and home health

agencies in Louisiana. Quality Insider is a publication

of eQHealth Solutions, the Medicare Quality Improve-

ment Organization for Louisiana, under contract with

the Centers for Medicare & Medicaid Services (CMS),

an agency of the U.S. Department of Health and Hu-

man Services. The contents presented do not necessarily

reflect CMS policy. LA9SoW1A2B3C4D5E6F10-M2242

Produced by the eQHealth Communications Team

Lisa Stansbury, MHSA

Director of Communications

Debbie Leone

Senior Communications Specialist

Brandon Campo & Maryann Rowland

Communications Coordinators

Ron Ritchey, MD, MBA

Chief Medical Officer, eQHealth Solutions

Non-Profit OrganizationU.S. Postage

PAIDBaton Rouge, LAPermit No. 571

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PHYSICIAN MEMBERSHIP REQUEST - FAX BACK FORMI, the undersigned, as a practicing physician in the State of Louisiana, hereby request membership in eQHealth Solutions and agree to the

Articles of Incorporation and Bylaws of this organization available at 8591 United Plaza Boulevard, Suite 270, Baton Rouge, Louisiana

70809. I am aware there are no membership fees. (Please print.)Date: _____________________________________

Name: __________________________________________Signature:_______________________________________________

Business Name: __________________________________________________________________________________________

Please fill out your membership information below and fax it to us today.

Address: _________________________________________City, State & Zip: _________________________________________

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I would like to receive information about becoming a Physician Reviewer for eQHealth.

I would like to receive quality updates, meeting notices and other information from eQHealth via: Mail E-Mail No preference

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