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Friday, February 22, 2008

Accountability + Transparency = Improved Quality + Patient Safety

Building & Leading a Continuous Improvement Culture

As I roam the internet looking for new knowledge and ideas on how to improve External Peer Review,I'm amazed at the plethora of statistics, data, measures and analysis that's being done in the name of improving hospital quality and patient safety. My hat goes off to those who use analytical tools as the foundation for performance improvement in hosptials.

Having said that, in my humble opinion, we could make much great strides in much shorter time if management and medical staff focused more of its effort on building accountability and transparency into their hospital cultures, as opposed to spending more time and money crunching numbers.

An increased emphasis on setting clearer practitioner expectations, measuring and monitoring their performance, sharing performance data and holding poor performers accountable is what's in order. We see/hear of too many situations in hospitals across the country where conflict of interest, conflict avoidance, cover-ups and other behavioral dysfunction allow under-performing physicians to keep doing what they are doing.

What I'm advocating is medical staff leadership that goes beyond analysis and statistics, but rather uses this data to place increased emphasis on creating a culture of continuous improvement. In such a culture, sentinel event data is openly shared, performance is actively measured, practitioner work is subjected to regular/period external peer review, and poor performers are put on a corrective action program, no matter who/how important they are.

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Wednesday, February 06, 2008

Making UR & Claims Determinations Easier for Healthcare Payers

If you're a utilization review or claims professional dealing with acute or chronic care populations, you probably deal with lots of cases that fall outside your normal criteria or plan language, and into the "gray zone." As you know, the standards of care are rapidly changing with emerging medical treatments, new technologies , drugs, etc. As a managed care professional, it's impossible to stay up on all of the latest changes in care management. What to do?

We've created a publication called "The Cutting Edge," which is designed to help critical and complex claims professionals stay on top of changing standards of care. Each issue features articles written by top specialists who are experts in their respective fields, who are board certified and in active practice. In these articles, you'll find information that will help you make more informed retrospective and pre-certifications decisions, based on the latest medical evidence.

Interested in signing up to receive a free copy? Click here: http://www.allmedmd.com/peerpoints/cuttingedge/cutting_edge_form.htm

-AGR

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External Peer Review Solves Hospital Performance Reporting Issues

Most Doctors Do Not Report Incompetent Colleagues, Survey

Written by: Catharine Paddock
http://www.medicalnewstoday.com/articles/90676.php

This article summarizes a recent national survey of physicians that indicates a serious discrepancy between the number of doctors who believe they should report incompetence (96%) and the number that actually do (45%). Conflict of interest is the key issue here, where physicians are either friends or economic foes. This study strongly supports the need for independent mechanisms that ensure evidence-based measurement of physician performance on a systematic and ongoing basis. Internal peer review committees often fail to address these types of issues. External medical peer review can go a long way toward helping to close this gap, while ensuring that poor performance is identified and dealt with in a fair and consistent way.

Survey:
"Professionalism in Medicine: Results of a National Survey of Physicians."
E. G. Campbell, S. Regan, R. L. Gruen, T. G. Ferris, S. R. Rao, P. D. Cleary and D. Blumenthal.
Ann Intern Med 2007; 795-802.
4 December 2007, Volume 147 Issue 11, Pages 795-802.

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