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Quality of care review.

Discussion in 'Anesthesiology' started by urge, Dec 28, 2008.

  1. urge

    10+ Year Member

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    My hospital started reviewing records for quality of care indicators. Hypothermia, beta blockers, antibiotic administration, dvt prophylaxis, etc... are being tracked. Yours truly has apparently missed a few of them and was kindly reminded by the Medical Staff director. Any other places doing the same?

    3 strikes, you are out?
     
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  3. jetproppilot

    jetproppilot Turboprop Driver
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    Don't take it personally.

    From the hospital's point of view ITS ALL ABOUT THE REIMBURSEMENT BENJAMINS.

    Our CRNAs review every chart to make sure all that crap is documented.

    Just another reflection of the (poor) times of being a doctor.....

    just haffta learn to play the game.
     
  4. Planktonmd

    Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    This is just the beginning!
    It's going to get worse and there is nothing we can do about it.
    All I hope for is I get to retire before I see the day when the insurance company will send you a list of medications that you are allowed to use on their "client" if you want to get paid.
     
  5. sevo85288

    sevo85288 Junior Member
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    yes, we monitor SCIP protocols.
     
  6. Gator05

    Gator05 Resident
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    Heh. Beta blockers: "See POISE trial results".

    Hypothermia: "Forced air warmer, room temp maximum (or limited per surgeon despite warnings of patient temp), warmed IVF" not much more I can do for adults

    Glucose: "Insulin started, 0.5 units/hour IV" (for sugars just outside the range on our pump cases).

    Now whenever I get a new requirement, I ask for their evidence. Our newest is no bags in the OR. Now, I don't necessarily disagree with this, but I want to see the evidence.
     
  7. Gern Blansten

    Gern Blansten Account on Hold
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    Are you referring to "old bags?" How many circulating nurses lost their jobs over this one?
     
  8. coprolalia

    coprolalia Bored Certified
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    It's called "Pay for Performance" (or "P4P"... f**kers have already given it a cutesy acronym). It is just another nail in the coffin of individualized medical care, and we will be treating algorithms - not patients - in the very near future. If you go off the script, you better be prepared to take a monetary hit.

    -copro
     
  9. jwk

    jwk CAA, ASA-PAC Contributor
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    You're just starting? We've been doing this on some level for years. QI, QA, CQI, whatever the current acronym might be. Unfortunately, it ain't going away. We've got people at our billing office that review the charts as well for non-clinical issues (times on chart, everything signed, dated, etc.)
     
  10. Gator05

    Gator05 Resident
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    There was a great calculation made a few years ago that the cost of implementing (and charting and auditing) p4p measures wasn't worth the extra money in reimbursement.
     
  11. 2ndyear

    2ndyear Senior Member
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    I don't necessarily agree with P4P as it is being implemented, but ours aren't THAT bad yet... The 'never ever' list is downright scary for internists. Bedsores? Falls in the hospital? Sure, you can take measures to reduce those, but old people will get bedsores, and they will fall sometimes causing themselves harm. I don't think that those should be never evers. Central line infections are an interesting one. BID has really been on top of this one and it looks like it is working through fairly simple measures.
     
  12. jwk

    jwk CAA, ASA-PAC Contributor
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    I don't know that it's really "extra" anymore. I get the impression it's more along the lines of "do this or don't get paid at all".
     
  13. cchoukal

    cchoukal Senior Member
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    This has become a really big deal at our program and we devote time every week at grand-rounds to cover some of these issues and the evidence behind them. Nearly without exception, the evidence is quit poor. So poor, in fact, that no one really believes the gov't could possibly believe that these measures will improve quality (even if the measures can be achieved), but rather, as many have pointed out here, they are part of a more sinister plan to deny or reduce payment. For the current BB mandate (that people taking them prior to surgery continue them in the perioperative period), there is at least an opt-out as long as you can document why the BB was contraindicated.

    Our dept has created a check-off form with the appropriate language to document the medical decision, but this is just one more BS form to comply with a BS rule that will further divert money, time, and effort from actual patient care to satisfy some asshat with an MBA so that he can get a bonus. The whole thing makes me sick. We are truly becoming "labor" at the whims of "management," and mangement is a 28 year old B-school graduate looking to score a holiday bonus.

    JWK makes a good point. The future of P4P is probably not EXTRA money, but rather an ever-increasing proportion of total reimbursement will be dependent upon documenting compliance with these mandates.

    The party is over.
     

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