Intolerance for diagnostic errors is just one of the top quality issues to watch for in 2014.
Pressure to reduce medical diagnostic errors and continue cutting healthcare costs will only increase in 2014.These healthcare quality issues and several others (see Part 1) will have a strong influence on how providers deliver healthcare in 2014:
8. Meaningful Use
With billions of dollars in meaningful use incentive payments at stake, hospitals and healthcare providers will be working hard to refine their electronic health record systems, transitioning from merely using them to actually exchanging information with other providers within them and sharing information with patients through the "view, download, and transmit" requirements.
Also beginning in 2014, eligible hospitals anticipating Medicare reimbursement must electronically report on 16 of 29 approved clinical quality measures and other Medicare-eligible providers must report on nine of 64 approved clinical quality measures, which include nine recommended for adult patients and nine recommended for pediatric patients.
The full list of clinical quality measures applicable for meaningful use incentive payment is here.
9. Physician Sunshine Act
Physician ties and financial dealings with pharmaceutical and medical device companies will now be discoverable by patients per a key provision of the Patient Protection and Affordable Care Act.
Any payments to doctors made by manufacturers of drugs, devices, biological, or medical supplies that are reimbursed by Medicare, Medicaid or the Children's Health Insurance Program will be publicly reported starting Sept. 30 under the Physician Payments Sunshine Act.
The Centers for Medicare & Medicaid services said in its final rule establishing these requirements that "payments from manufacturers to physicians and teaching hospitals can also introduce conflicts of interest that may influence research, education, and clinical decision-making in ways that compromise clinical integrity and patient care, and may lead to increased health care costs."
See Also: Top Healthcare Quality Issues for 2014, Part 1
When posted online, the data will be "downloadable, easily searchable, and aggregated," the rule requires.
This month, CMS is expected to launch the physician portal that by March 31, will receive reports from group purchasing organizations and manufacturers. Over the next several months, physicians will be able to see these reports through a web portal.
10. Cutting Costs Everywhere
With CMS under much more pressure to release hospital charges and payments, expect more scrutiny and comparison of elective procedures costs to patients. In anticipation of this and expected reductions in payments through penalties and lost incentive payments, hospitals are eliminating many procedures from their order sets that don't add value or improve patient outcomes.
Better blood management in transfusions, less variation in surgical technologies, better supply chain management, greater use of generics instead of brand name drugs, and greater education and awareness for physicians to know the actual costs of hospital care are priority initiatives at most organizations.
Hospitals also are moving toward more efficient use of staffing, which may mean nurse practitioners and physicians assistants performing some activities previously done only by physicians.
11. Choosing Wisely
A buzzword among physician specialty groups, the Choosing Wisely campaign launched two years ago by the American Board of Internal medicine Foundation is increasingly relevant in hospital care as well as in ambulatory settings.
Guidance from the American Society of Anesthesiologists, Society for Vascular Medicine, American College of Surgeons, and the Society of Thoracic Surgeons are just some of the professional groups that have issued lists of procedures previously performed in acute care settings that may likely be ill advised.
While most of 50 physician societies have published a list of five procedures or tests they say patients and their providers should question, the Society of Hospital Medicine has published a list of 10.
12. Cost Data Feedback Loops
Physicians and hospitals are starting a major push to get CMS to release Medicare fee-for-service data. That's necessary in order for payers and hospital organizations to measure and evaluate provider performance and healthcare utilization, wrote Donald Berwick, MD, former CMS administrator and John Toussaint, MD, ThedaCare Center for Healthcare Value in Appleton, WI in the Journal of the American Medical Association.
A provision of the healthcare reform law permits such Medicare claims data to be released to "qualified entities" that meet certain criteria, but according to CMS, only 12 QEs have been certified to receive this information, and those cover "relatively small population bases," Toussaint and Berwick wrote.
"Progress has been slow because the legislation tightly limits what organizations can do with the data… Giving physicians access to the data set for specific group-to-group comparisons or for analysis of their own weak areas of performance—is not permitted."
"The hard lesson from the front lines is that you really can't change anyone's behavior unless you build feedback loops into the care system using timely, accurate information," says James LaBelle, MD, Senior Vice President, Chief Medical Officer for Scripps Health in San Diego. "This basic fact seems to be unrecognized by policy makers."
LaBelle, Berwick and Toussaint make the point that providers need this information to, in LaBelle's words, "build accountabilities and engineer changes into the health system…The real work to sustainable improvement is building the feedback loops into the care delivery and management systems that actually create the pressure in day-to-day operations to drive change."
13. Competing Hospital Rating Systems
At least seven organizations now publish annual lists of the nation's top or best or safest hospitals, and many of these lists are wildly divergent in their rankings. Most of these charge hospitals to use their scores in marketing materials, putting additional pressure on acute care facilities to keep up the ratings game in increasingly competitive markets.
At some point, some organization is certain to bring sanity to the ratings cacophony with a template for what evaluation factors are appropriately used to judge a facility.
See Also: Top Healthcare Quality Issues for 2014, Part 1
Expect such a system to weigh the importance of myriad factors such as reputation, volume, claims data, safety data reported to CMS, geography and size, research funding and number of trials, hospital charges, hospital teaching status, number of physicians on staff, and so on.
14. Misdiagnosis as a New Form of Preventable Harm
What if for every seven days that you went to work, your job performance was excellent for six solid days. But every seventh day your performance suffered. You made mistakes and exercised bad judgment. You'd be fired for sure.
New studies call into question physician diagnostic proficiency, saying they get it wrong about as often, between 10% and 15% of the time. And they are seldom held accountable, although that culture is starting to change, says Hardeep Singh, MD, an associate professor at Baylor College of Medicine, who is pushing to raise the importance of misdiagnosis to the level of other types of preventable medical errors.
"Fortunately, our field is beginning to attract the attention that we have long hoped for," he wrote in an editorial last October in the British Medical JournalQuality & Safety.
Accountable care organizations, and other forms of shared savings plans and cooperative care networks such as patient-centered medical homes may create incentives for hospitalists and clinicians to circle back to the diagnosing doctor who didn't get it right. Also, a new organization called the Society to Improve Diagnosis in Medicine (SIDM) is working on diagnostic error terminology and has received support from the Agency for Healthcare Research and Quality.