Article concludes: “Wide range of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers.” (NEJM, Feb 16) Click here to read full text.
Medical Staff Updates
Folic Acid Supplementation for the Prevention of Neural Tube Defects: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Forceby jmiller on February 2, 2017
“In studies conducted before the initiation of food fortification in the United States in 1998, folic acid supplementation provided protection against neural tube defects. Newer postfortification studies have not demonstrated a protective association but have the potential for misclassification and recall bias, which can attenuate the measured association of folic acid supplementation with neural tube defects” (JAMA, Jan 10) Click here to read full text.
Clinical Guideline: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physiciansby jmiller on February 2, 2017
“ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events. (Grade: weak recommendation, low-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient.” (Ann Intern Med, Jan) Click here to read full text.
In the news: Use of CT and chest radiography for lung cancer screening before and after publication of screening guidelines, intended and unintended uptakeby jmiller on February 2, 2017
“The National Lung Screening trial (NLST) released its main findings in 2011,concluding that the use of low-dose findings in 2011, concluding that the use of low-dose computed tomography (CT) to screen for lung cancer reduced lung cancer deaths by 20% compared with chest radiography. The subsequent publication of new lung cancer screening (LCS) guidelines may raise the public’s awareness of the clinical application of low-dose CT in screening, leading to increased demand for screening not only by individuals who meet the eligibility criteria recommended for LCS but also by those who do not. The first finding show a high rate of incidental findings (41%), a low rate of detection of lung cancer, and all for a highly resource-intensive program. From the data reported, we calculate that for every 1000 people screened, 10 will be diagnosed with early-stage lung cancer (potentially curable), and 5 with advanced-stage lung cancer (incurable); 20 will undergo unnecessary invasive procedures (bronchoscopy and thoracotomy) directly related to the screening; and 550 will experience unnecessary alarm and repeated CT scanning. Screening should be limited to patients most likely to benefit. (JAMA Intern Med, early online) Click here to read full-text.
Looking for an Advanced Alternative Payment Model (AAPM)? The CCN’s primary focus is to offer a portfolio of AAPMs to as many CCN-member clinicians as possible. Being in an AAPM provides several benefits: 1) automatic five percent Medicare bonus 2) significant relief from reporting burdens 3) opportunities to achieve greater incentive payments 4) a larger Medicare rate increase in 2026 and beyond and 5) resources to improve patient outcomes.
AAMC has recently submitted a Letter of Intent to participate in the state’s Hospital Care Improvement Program (HCIP) in 2018. HCIP is expected to be approved by Medicare as an AAPM for hospital-based clinicians, meaning it will offer the benefits listed above. Clinicians interested in participating in AAMC’s HCIP will need to be members of the Collaborative Care Network. The HCIP applies to inpatient care and has the following objectives:
- To enhance the quality of patient care by adoption of evidence- based and other standardized practices
- To improve physician and organizational efficiencies in providing patient care
- To reduce the cost of care and eliminate medically unnecessary services
Providers participating in HCIP will benefit through:
- Participation in programs designed to meet Medicare Access and CHIP Reauthorization Act (MACRA) requirements
- Potential financial incentives from the hospital for performing activities that will improve care, reduce potentially avoidable utilization (PAU) and reduce the total cost of care (TCOC)
- Access to detailed reports to allow physicians to improve their individual performance, and achieve greater incentive payments and improved patient outcomes over time
There are more Care Redesign Programs currently in development at the state levels that will include outpatient care. The CCN will support local practices in these programs as well. We are building the infrastructure to be successful together in the era of payment reform and care transformation.
For more information on the CCN, or to learn how your practice can join, please contact Renee Kilroy at email@example.com or 443-481-6619.
The Institute of Medicine’s groundbreaking report, “To Err Is Human,” highlights the importance of patient safety in health care organizations. This report, along with emphasis from many health care improvement entities such as the Joint Commission, triggered a renewed effort among health care organizations nationwide to eliminate medical errors and improve patient safety.
“One of the first steps in creating a safer health care organization is establishing a culture of safety. High reliability organizations emphasize safety as a fundamental priority that we continually strive to improve upon. A safety culture flourishes when…”
- We learn about patient safety from the successes and positive events that occur in health care every day to build strong patient safety programs.
- We examine our approaches and, therefore, increase safety and actively prevent harm.
- We report events and, ultimately, seek understanding and value through other experiences that lead to safer care and practices.
- We think and act in the manner necessary to develop successful solutions, find answers, overcome obstacles, and deliver results to ensure safety.
- We provide a learning environment that is constantly improving and focused on patient safety.
AAMC has been pursuing a culture of safety, in which front-line operators and others are not punished for actions, omissions or decisions that commensurate with their experience and training where gross negligence, willful violations and destructive acts are not tolerated. A culture of safety safety is created through the collective attitudes and values of a group of people. To achieve a safety culture, each one of us in the organization must embrace a safety mindset and support each other in our safety efforts.
Patient safety affects everyone at AAMC. Building a safer culture depends on our ability to listen and learn from all members of the health care team.
Beginning Feb. 6 through Feb. 20, we are once again participating in the Agency for Healthcare Research and Quality AHRQ Safety Culture Survey. This survey will enable AAMC to assess how staff and medical staff perceive various aspects of our patient safety culture, and will also:
- Raise staff awareness about patient safety.
- Diagnose and assess the current status of our patient safety culture.
- Identify strengths and areas for patient safety culture improvement.
- Examine trends in patient safety culture change over time.
- Evaluate the cultural impact of patient safety initiatives and interventions.
Our goal is to get a response rate of at least 80 percent of all employees. The survey is very easy to complete. We encourage all staff to participate in this essential initiative, so that quality and patient safety remain high priorities here at AAMC.
Pathology Update: New PCR Testing Available for Routine Antepartum Screening Available Jan. 9; New Group B Streptococcus LIM Broth-Enriched Molecular Testby Medical Staff Office on January 9, 2017
From Sanford Robbins III, MD, Chief Pathologist, and Jacqui Kozireski, Microbiology Lab Manager
We are pleased to announce that the Cepheid Xpert GBS LB (Group B Strep LIM broth enriched) is a qualitative real-time PCR test used to detect GBS DNA from LIM broth culture of vaginal/rectal swabs after 18 to 24 hours of incubation. This test is for antepartum testing (35-37 weeks).
Conventional methods of culturing are less sensitive and can take up to 72 hours from collection to reporting. The combination of LIM broth enrichment and PCR provides reduced turnaround time with an extremely sensitive and specific method to detect GBS colonization in antepartum women, which fulfills the CDC (November, 2010) recommendations for testing. Results will be reported in 20 to 24 hours as compared to the three-day turnaround of current culture methods.
Routine susceptibility testing will only be performed on those patients who are penicillin-allergic at the request of the physician, and can be requested up to three days post collection or indicated when the test is ordered. Susceptibility testing will require an additional two to three days when requested.
Specimen collection: Use Remel BactiSwab (double swab) provided by the lab as long as testing is sent to us. PAR levels will be monitored periodically. We will no longer accept gel swabs as this is incompatible with PCR testing.
Store specimens refrigerated and transport to the lab within 24 hours of collection. Patients who have used systemic or topical (vaginal antibiotics in the week prior or patients with placenta previa should not be tested.)
On written/printed orders, please specify:
- Group B Strep, Lim Broth PCR (Antepartum Only)
- Group B Strep Lim Broth, PCR w/Sens (Antepartum Only) for Penicillin Allergy
Contact the Microbiology Laboratory at 443-481-4232 with questions or if further testing is needed.
In the days of “no questions asked,” fee-for-service payment, our medical community thrived as a cottage industry, each of us humming along independently, minding our own business. But now with state and national initiatives tying our payment to outcomes, our local “cottages” of care need to recognize one another and benefit from our interdependencies. No individual clinician or practice can alone shoulder the burden of cost and quality improvement for patients. Imagine being accountable for a patient’s outcomes and not knowing where, how or from whom he/she is getting care, or whether his/her other clinicians have the same goals and incentives as you. The missing ingredient is clinical integration, which requires aligning goals and incentives across settings of care, and sharing data and resources to ensure mutual success in promoting better health outcomes. Clinical integration is more than just infrastructure: it creates the culture that recognizes medical professionals’ roles and expertise in delivering appropriate care efficiently.
Why is clinical integration important? Maryland is accelerating the move to linking practice-based care to hospital-based care by “MACRA-tizing” our state’s unique all-payer model through the provision of a growing number of advanced alternative payment models (AAPMs) for physicians to choose from. Maryland AAPMs currently in development provide opportunities for specialists, primary care physicians and hospital-based clinicians to collaborate locally with each other and their hospitals. Physicians are attracted to AAPMs because their participation in an AAPM relieves physicians from the significant reporting burdens of MIPS (merit-based incentive payment system) and provides five percent annual bonus in Medicare payment, in addition to potential further financial rewards from the AAPM itself.
Achieving success in AAPMs depends upon recognizing interdependencies and aligning goals among providers of care. The AAMC Collaborative Care Network (CCN) is your local, physician-led platform that enables our own medical community to share data, resources and AAPM opportunities. The CCN is your clinically integrated network, formed for our own medical community and the patients we serve together.
Currently, the CCN has more than 400 clinician members. Our objectives are:
- AAMC (private and employed) clinicians together taking responsibility for the cost and quality of care for populations;
- Shared responsibility between AAMC clinicians (both private and employed) for the cost and quality of care for populations;
- Better coordination of care across settings and clinicians;
- More effective management of chronic disease by both clinicians and patients;
- Measurable improvement in health outcomes;
- Successful performance in pay-for-value programs;
- Enhanced role satisfaction of clinicians;
- Building a community of practice recognized and preferred by patients.
For more information on the CCN, or to learn how your practice can join, please contact Renee Kilroy at rkilroy@AAHS.org or 443-481-6619.