Medicare Contractor Advisory Committee Hears Presentation on Quality
The Medicare Contractor Advisory Committee (formerly called the Carrier Advisory Committee) met at the Maine Medical Association on June 21, with the meeting broadcast via videoconferencing to sites in New Hampshire, Vermont and Massachusetts.
Following introductions by CAC Co-Chair Stephen Black-Schaffer, M.D., John D. Birkmeyer, M.D., presented on the topic of, "Making Surgery Safer: Volume and Beyond." Dr. Birkmeyer, formerly at Dartmouth Medical School, is currently the George D. Zuidema Professor at the University of Michigan and its Chair of the Center for Surgical Evaluation and Policy.
Dr. Birkmeyer's talk centered around the assertion that bad outcomes in surgery are common and that the chance of a bad outcome depends on where and by whom the surgery is performed. By implication, Dr. Birkmeyer noted that a large number of bad outcomes are avoidable. He stated that there were two pathways to improving surgical outcomes, the first being to direct patients to the best surgeons or the best hospitals, the second was to improve care across the board. As means to achieve this improvement, Dr. Birkmeyer cited three trends:
* Heightened patient consciousness (e.g. media)
* Giving patients/PCPs access to provider specific information (e.g. public reporting)
* Selective contracting by payers and health plans (Leadfrog Group)
Dr. Birkmeyer spoke of Leapfrog's three safety standards: computer order entry, ICU staffing by board-certified physicians, and volume and mortality standards. He cited the work of the Northern New England Cardiovascular Study Group (l987 to date) as particularly notable.
Dr. Birkmeyer stressed that there were pros and cons associated with each of the two strategies and made recommendations for moving forward in improving outcomes. He discussed how to get to data and how to select measures appropriate to a particular procedure. He discussed, "How well do measures predict FUTURE performance." He encouraged the profession to better delineate processes that matter.
Paper copies of Dr. Birkmeyer's presentation are available from MMA (call Julie Banta at 622-3374 or firstname.lastname@example.org.
Following Dr. Birkmeyer's talk, CMS Regional Administrator Charlotte S. Yeh, M.D., FACEP spoke on the Medicare Modernization Act (MMA). Dr. Yeh reminded CAC members that while the Medicare prescription drug benefit was the center piece of the legislation, there were several other parts of the 776 page bill that are important to physicians but which few physicians are aware of. She noted the improved coverage for preventive services and provisions regarding new technology, as well as the positive changes to physician payments.
Dr. Yeh also noted the very significant changes to the Contractor process, the establishment of regional PPO's and competitive bidding for local "Medicare Advantage Plans." She also discussed the quality initiatives in the legislation and the changes in EMTALA. (Dr. Yeh practiced as an emergency physician and was considered a national expert on EMTALA prior to her entering a new career at CMS).
Physicians may go to the CMS website at www.cms.hhs.gov/medlearn/matters/ for more information. Paper copies of Dr. Yeh's presentation are available at MMA (call Julie Banta at 622-3374 or jbanta @mainemed.com.
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