Jill Epstein

The Performance and Standards Task Force (PSTF) was formed in May 2006 when SHM leadership recognized the need for a coordinated approach to working with other organizations in the quality arena.

A task force normally would have a beginning and an end to its scope of work. However, PSTF’s ongoing mission has matured, becoming more and more engaged in quality activities. In late fall 2007, the time had come for the PSTF to evolve into SHM’s Performance and Standards Committee (PSC).

What We Do

As SHM’s senior adviser for quality standards and compliance, I continue to work with PSC Chair Patrick Torcson, MD, along with senior staff and leadership of the Public Policy Committee (PPC), to monitor the national performance and quality landscape. The PSC, which engages with national organizations and is charged with developing performance measures and building consensus, also works to develop relationships with other professional medical societies and organizations.

Recognizing the need to communicate more frequently on SHM quality/policy issues related to quality improvement and patient safety, the PSC has also forged a stronger tie with the Hospital Quality and Patient Safety Committee (HQPSC) and was represented in the HQPSC-led Quality Summit in October.

Through the PSC, SHM has worked to influence performance measure development, consensus, and the endorsement process by joining the AMA Physician Consortium for Performance Improvement (PCPI) and the National Quality Forum (NQF).

Broader Reach

SHM members have contributed to the process by participating in activities relevant to hospital medicine and building relationships with senior staff and leadership within these national stakeholder groups.

The PCPI is committed to enhancing quality of care and patient safety by taking the lead in the development, testing, and maintaining evidence-based clinical performance measures and performance measurement resources for physicians. The NQF is a nonprofit organization charged by Congress to endorse consensus-based national standards for measurement and public reporting of healthcare performance data. Beginning in 2006, the PCPI and NQF have worked to influence the development of physician-level performance measures as part of the CMS Physician Quality Reporting Initiative (PQRI). Joining the PCPI has given SHM the opportunity to participate with other organizations on expert work groups to develop performance measures. SHM has been involved in performance measure development for topics such as geriatrics, emergency medicine, outpatient parenteral antimicrobial therapy, and anesthesiology issues including perioperative normothermia and critical care.

Many of these measures have been included in the PQRI program. SHM submitted feedback during public comment periods on measures related to perioperative care and chronic kidney disease. Most importantly, PCPI participation has given SHM high visibility among measurement stakeholder groups, including CMS and NQF. This has raised the acceptance of hospital medicine as a specialty, as well as the influence and credibility of SHM as a professional society.

As a collaborative effort on behalf of SHM, the PSC and PPC drafted and submitted a comment letter on the 2008 Centers for Medicare and Medicaid Studies (CMS) Proposed Rule regarding the future of the PQRI. SHM has supported the CMS value-based purchasing initiative and the PQRI in general. The PSC recommended that CMS and national stakeholder groups like the PCPI and NQF re-evaluate the denominators of several measures, existing and proposed, to make them applicable to the inpatient setting for hospitalist reporting.

PSC senior staff attended the PCPI meeting in Chicago last October and met with Susan Nedza, MD, of the CMS Special Program Office, Value-Based Purchasing, to express SHM’s appreciation of increased CMS recognition of hospitalists through its quality initiatives. This also was an opportunity to receive input on additional ways hospitalists can become engaged in the 2008 PQRI and other CMS quality efforts.

PQRI Success

In early November, Dr. Nedza and her staff, Dr. Torcson, and SHM senior staff met via conference call to discuss the preliminary results of the 2007 PQRI and exchange thoughts on the program related to hospitalists. A concern for hospitalists was the intent for the PQRI to include performance measures for each of the 39 medical specialties recognized by CMS; hospitalists were lumped under general internal medicine. By working closely with CMS and the PCPI, SHM succeeded in achieving denominator specification changes for additional relevant measures to become available for hospitalist reporting through the 2007 PQRI.

Soon thereafter, the CMS Final Rule on Physician Payment was released, indicating that 10 of the 11 measures available for hospitalist reporting in the 2007 PQRI also were to be included for 2008. “Beta-blocker on Arrival for Acute Myocardial Infarction” was the one measure no longer part of the 2008 PQRI. One new measure available for hospitalist reporting in 2008 is measure No. 75, “Prevention of Ventilator-Associated Pneumonia—Head Elevation,” for which hospitalists can report using a critical care code.

The 2007 PQRI included the following measures on which hospitalists could report:

• No. 5: “Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)”;
• No. 6: “Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease”;
• No. 7: “Beta-blocker Therapy for CAD Patients with Prior Myocardial Infarction”;
• No. 29: “Beta-blocker at Time of Arrival for Acute Myocardial Infarction”;
• No. 31: “Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis”;
• No. 32: “Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy”;
• No. 33: “Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge”;
• No. 34: “Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator Considered”;
• No. 35: “Stroke and Stroke Rehabilitation: Screening for Dysphagia”;
• No. 36: “Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services”; and
• No. 47: “Documentation of an Advanced Care Plan.”

After the final specifications for the 2008 PQRI were released, there was a proposal for denominator specification changes that would preclude inpatient reporting for many of the measures relevant and available to hospitalists in 2007. The PSC again worked closely with the PCPI and relevant professional organizations to preserve the measure specifications for the 2008 PQRI to allow inpatient and thus hospitalist reporting. This experience has further enhanced productive SHM relationships with the PCPI and CMS.

The PSC has an ongoing commitment to recommend SHM members for appointments to PCPI expert measure workgroups, depending on the topic. For example, SHM was recently asked to identify a member to join a newly forming asthma measures workgroup that will be looking to develop inpatient measures. SHM will be notified when a palliative care measures workgroup is being formed.

Senior staff and leadership will meet PCPI senior staff to discuss formation of an expert workgroup on care transitions measures. This work group will be co-chaired by SHM and the American College of Physicians (ACP) and include societies such as the Society of General Internal Medicine (SGIM), the American Geriatrics Society (AGS), and others engaged in the development of the transitions of care consensus document in summer 2007. The work group also will refer to the principles and standards that resulted from the ABIM Foundation’s Stepping Up to the Plate (SUTTP) Alliance as a resource in its development of measures.

Looking ahead to the 2009 PQRI, the PSC has requested measure specification changes to the following PQRI measures:

• No. 56: “Vital Signs for Community Acquired Pneumonia”;
• No. 57: “Oxygenation Assessment for Community Acquired Pneumonia”;
• No. 58: “Assessment of Mental Status for Community Acquired Pneumonia”; and
• No. 59: “Empiric Antibiotic for Community Acquired Pneumonia.”

These measures harmonize with the Joint Commission’s core measures and are relevant for hospitalist performance reporting.

With the NQF

On Sept. 26-28, PSC member Greg Seymann represented SHM at NQF’s 8th Annual Meeting in Washington, D.C. This meeting featured plenary sessions focusing on issues at the forefront of policy discussions related to quality of care including:  

• Chronic care episodes across care settings;
• Medications and quality;
• Medicare performance monitoring and payment initiatives;
• Moving performance measures into electronic health record requirements; and
• Nursing leadership in measurement activities and achieving higher performance.
• In the first quarter of 2008, the PSC has:
• Reviewed and commented on NQF’s “National Voluntary Consensus Standards for Hospital Care: Additional Priorities–2007, Part 2”;
• Sent a representative to the steering committee for the National Voluntary Consensus Clinician-Level Perioperative Care Standards meeting;
• Submitted nominees for the National Voluntary Consensus Standards for Emergency Care Phase II steering committee and the Prevention and Management of Stroke Across the Continuum steering committee (our nominee was accepted for the latter);
• Reviewed and commented on the National Voluntary Consensus Standards for Prevent­­ion and
• Care of Venous Thromboembolism: Performance Measures/Phase II; and;
• Has sent senior leadership and staff to the NQF Spring Meeting and Implementation Conference on Care Coordination.

In the Works

The PSC and the HQPSC submitted a comment letter on CMS’ selection of hospital-acquired conditions and present on admission indicator reporting for 2009. SHM supported CMS’ efforts to improve the quality of care for hospitalized patients by preventing avoidable hospital-acquired conditions and outlining its concerns regarding unintended consequences as relates to the various conditions.

With its new status as the PSC, this enthusiastic and committed group is preparing to extend its mission and scope of work in 2008.

The PSC plans to restructure and serve as expert liaisons for internal and external activities. This not only will empower committee members to become more engaged in our performance agenda, but also allow them to serve as key contacts for staff when monitoring the ever-growing landscape of performance measurement, quality, and policy. TH

The Performance and Standards Task Force (PSTF) was formed in May 2006 when SHM leadership recognized the need for a coordinated approach to working with other organizations in the quality arena.

A task force normally would have a beginning and an end to its scope of work. However, PSTF’s ongoing mission has matured, becoming more and more engaged in quality activities. In late fall 2007, the time had come for the PSTF to evolve into SHM’s Performance and Standards Committee (PSC).

What We Do

As SHM’s senior adviser for quality standards and compliance, I continue to work with PSC Chair Patrick Torcson, MD, along with senior staff and leadership of the Public Policy Committee (PPC), to monitor the national performance and quality landscape. The PSC, which engages with national organizations and is charged with developing performance measures and building consensus, also works to develop relationships with other professional medical societies and organizations.

Recognizing the need to communicate more frequently on SHM quality/policy issues related to quality improvement and patient safety, the PSC has also forged a stronger tie with the Hospital Quality and Patient Safety Committee (HQPSC) and was represented in the HQPSC-led Quality Summit in October.

Through the PSC, SHM has worked to influence performance measure development, consensus, and the endorsement process by joining the AMA Physician Consortium for Performance Improvement (PCPI) and the National Quality Forum (NQF).

Broader Reach

SHM members have contributed to the process by participating in activities relevant to hospital medicine and building relationships with senior staff and leadership within these national stakeholder groups.

The PCPI is committed to enhancing quality of care and patient safety by taking the lead in the development, testing, and maintaining evidence-based clinical performance measures and performance measurement resources for physicians. The NQF is a nonprofit organization charged by Congress to endorse consensus-based national standards for measurement and public reporting of healthcare performance data. Beginning in 2006, the PCPI and NQF have worked to influence the development of physician-level performance measures as part of the CMS Physician Quality Reporting Initiative (PQRI). Joining the PCPI has given SHM the opportunity to participate with other organizations on expert work groups to develop performance measures. SHM has been involved in performance measure development for topics such as geriatrics, emergency medicine, outpatient parenteral antimicrobial therapy, and anesthesiology issues including perioperative normothermia and critical care.

Many of these measures have been included in the PQRI program. SHM submitted feedback during public comment periods on measures related to perioperative care and chronic kidney disease. Most importantly, PCPI participation has given SHM high visibility among measurement stakeholder groups, including CMS and NQF. This has raised the acceptance of hospital medicine as a specialty, as well as the influence and credibility of SHM as a professional society.

As a collaborative effort on behalf of SHM, the PSC and PPC drafted and submitted a comment letter on the 2008 Centers for Medicare and Medicaid Studies (CMS) Proposed Rule regarding the future of the PQRI. SHM has supported the CMS value-based purchasing initiative and the PQRI in general. The PSC recommended that CMS and national stakeholder groups like the PCPI and NQF re-evaluate the denominators of several measures, existing and proposed, to make them applicable to the inpatient setting for hospitalist reporting.

PSC senior staff attended the PCPI meeting in Chicago last October and met with Susan Nedza, MD, of the CMS Special Program Office, Value-Based Purchasing, to express SHM’s appreciation of increased CMS recognition of hospitalists through its quality initiatives. This also was an opportunity to receive input on additional ways hospitalists can become engaged in the 2008 PQRI and other CMS quality efforts.

PQRI Success

In early November, Dr. Nedza and her staff, Dr. Torcson, and SHM senior staff met via conference call to discuss the preliminary results of the 2007 PQRI and exchange thoughts on the program related to hospitalists. A concern for hospitalists was the intent for the PQRI to include performance measures for each of the 39 medical specialties recognized by CMS; hospitalists were lumped under general internal medicine. By working closely with CMS and the PCPI, SHM succeeded in achieving denominator specification changes for additional relevant measures to become available for hospitalist reporting through the 2007 PQRI.

Soon thereafter, the CMS Final Rule on Physician Payment was released, indicating that 10 of the 11 measures available for hospitalist reporting in the 2007 PQRI also were to be included for 2008. “Beta-blocker on Arrival for Acute Myocardial Infarction” was the one measure no longer part of the 2008 PQRI. One new measure available for hospitalist reporting in 2008 is measure No. 75, “Prevention of Ventilator-Associated Pneumonia—Head Elevation,” for which hospitalists can report using a critical care code.

The 2007 PQRI included the following measures on which hospitalists could report:

• No. 5: “Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)”;
• No. 6: “Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease”;
• No. 7: “Beta-blocker Therapy for CAD Patients with Prior Myocardial Infarction”;
• No. 29: “Beta-blocker at Time of Arrival for Acute Myocardial Infarction”;
• No. 31: “Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis”;
• No. 32: “Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy”;
• No. 33: “Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge”;
• No. 34: “Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator Considered”;
• No. 35: “Stroke and Stroke Rehabilitation: Screening for Dysphagia”;
• No. 36: “Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services”; and
• No. 47: “Documentation of an Advanced Care Plan.”

After the final specifications for the 2008 PQRI were released, there was a proposal for denominator specification changes that would preclude inpatient reporting for many of the measures relevant and available to hospitalists in 2007. The PSC again worked closely with the PCPI and relevant professional organizations to preserve the measure specifications for the 2008 PQRI to allow inpatient and thus hospitalist reporting. This experience has further enhanced productive SHM relationships with the PCPI and CMS.

The PSC has an ongoing commitment to recommend SHM members for appointments to PCPI expert measure workgroups, depending on the topic. For example, SHM was recently asked to identify a member to join a newly forming asthma measures workgroup that will be looking to develop inpatient measures. SHM will be notified when a palliative care measures workgroup is being formed.

Senior staff and leadership will meet PCPI senior staff to discuss formation of an expert workgroup on care transitions measures. This work group will be co-chaired by SHM and the American College of Physicians (ACP) and include societies such as the Society of General Internal Medicine (SGIM), the American Geriatrics Society (AGS), and others engaged in the development of the transitions of care consensus document in summer 2007. The work group also will refer to the principles and standards that resulted from the ABIM Foundation’s Stepping Up to the Plate (SUTTP) Alliance as a resource in its development of measures.

Looking ahead to the 2009 PQRI, the PSC has requested measure specification changes to the following PQRI measures:

• No. 56: “Vital Signs for Community Acquired Pneumonia”;
• No. 57: “Oxygenation Assessment for Community Acquired Pneumonia”;
• No. 58: “Assessment of Mental Status for Community Acquired Pneumonia”; and
• No. 59: “Empiric Antibiotic for Community Acquired Pneumonia.”

These measures harmonize with the Joint Commission’s core measures and are relevant for hospitalist performance reporting.

With the NQF

On Sept. 26-28, PSC member Greg Seymann represented SHM at NQF’s 8th Annual Meeting in Washington, D.C. This meeting featured plenary sessions focusing on issues at the forefront of policy discussions related to quality of care including:  

• Chronic care episodes across care settings;
• Medications and quality;
• Medicare performance monitoring and payment initiatives;
• Moving performance measures into electronic health record requirements; and
• Nursing leadership in measurement activities and achieving higher performance.
• In the first quarter of 2008, the PSC has:
• Reviewed and commented on NQF’s “National Voluntary Consensus Standards for Hospital Care: Additional Priorities–2007, Part 2”;
• Sent a representative to the steering committee for the National Voluntary Consensus Clinician-Level Perioperative Care Standards meeting;
• Submitted nominees for the National Voluntary Consensus Standards for Emergency Care Phase II steering committee and the Prevention and Management of Stroke Across the Continuum steering committee (our nominee was accepted for the latter);
• Reviewed and commented on the National Voluntary Consensus Standards for Prevent­­ion and
• Care of Venous Thromboembolism: Performance Measures/Phase II; and;
• Has sent senior leadership and staff to the NQF Spring Meeting and Implementation Conference on Care Coordination.

In the Works

The PSC and the HQPSC submitted a comment letter on CMS’ selection of hospital-acquired conditions and present on admission indicator reporting for 2009. SHM supported CMS’ efforts to improve the quality of care for hospitalized patients by preventing avoidable hospital-acquired conditions and outlining its concerns regarding unintended consequences as relates to the various conditions.

With its new status as the PSC, this enthusiastic and committed group is preparing to extend its mission and scope of work in 2008.

The PSC plans to restructure and serve as expert liaisons for internal and external activities. This not only will empower committee members to become more engaged in our performance agenda, but also allow them to serve as key contacts for staff when monitoring the ever-growing landscape of performance measurement, quality, and policy. TH

The Performance and Standards Task Force (PSTF) was formed in May 2006 when SHM leadership recognized the need for a coordinated approach to working with other organizations in the quality arena.

A task force normally would have a beginning and an end to its scope of work. However, PSTF’s ongoing mission has matured, becoming more and more engaged in quality activities. In late fall 2007, the time had come for the PSTF to evolve into SHM’s Performance and Standards Committee (PSC).

What We Do

As SHM’s senior adviser for quality standards and compliance, I continue to work with PSC Chair Patrick Torcson, MD, along with senior staff and leadership of the Public Policy Committee (PPC), to monitor the national performance and quality landscape. The PSC, which engages with national organizations and is charged with developing performance measures and building consensus, also works to develop relationships with other professional medical societies and organizations.

Recognizing the need to communicate more frequently on SHM quality/policy issues related to quality improvement and patient safety, the PSC has also forged a stronger tie with the Hospital Quality and Patient Safety Committee (HQPSC) and was represented in the HQPSC-led Quality Summit in October.

Through the PSC, SHM has worked to influence performance measure development, consensus, and the endorsement process by joining the AMA Physician Consortium for Performance Improvement (PCPI) and the National Quality Forum (NQF).

Broader Reach

SHM members have contributed to the process by participating in activities relevant to hospital medicine and building relationships with senior staff and leadership within these national stakeholder groups.

The PCPI is committed to enhancing quality of care and patient safety by taking the lead in the development, testing, and maintaining evidence-based clinical performance measures and performance measurement resources for physicians. The NQF is a nonprofit organization charged by Congress to endorse consensus-based national standards for measurement and public reporting of healthcare performance data. Beginning in 2006, the PCPI and NQF have worked to influence the development of physician-level performance measures as part of the CMS Physician Quality Reporting Initiative (PQRI). Joining the PCPI has given SHM the opportunity to participate with other organizations on expert work groups to develop performance measures. SHM has been involved in performance measure development for topics such as geriatrics, emergency medicine, outpatient parenteral antimicrobial therapy, and anesthesiology issues including perioperative normothermia and critical care.

Many of these measures have been included in the PQRI program. SHM submitted feedback during public comment periods on measures related to perioperative care and chronic kidney disease. Most importantly, PCPI participation has given SHM high visibility among measurement stakeholder groups, including CMS and NQF. This has raised the acceptance of hospital medicine as a specialty, as well as the influence and credibility of SHM as a professional society.

As a collaborative effort on behalf of SHM, the PSC and PPC drafted and submitted a comment letter on the 2008 Centers for Medicare and Medicaid Studies (CMS) Proposed Rule regarding the future of the PQRI. SHM has supported the CMS value-based purchasing initiative and the PQRI in general. The PSC recommended that CMS and national stakeholder groups like the PCPI and NQF re-evaluate the denominators of several measures, existing and proposed, to make them applicable to the inpatient setting for hospitalist reporting.

PSC senior staff attended the PCPI meeting in Chicago last October and met with Susan Nedza, MD, of the CMS Special Program Office, Value-Based Purchasing, to express SHM’s appreciation of increased CMS recognition of hospitalists through its quality initiatives. This also was an opportunity to receive input on additional ways hospitalists can become engaged in the 2008 PQRI and other CMS quality efforts.

PQRI Success

In early November, Dr. Nedza and her staff, Dr. Torcson, and SHM senior staff met via conference call to discuss the preliminary results of the 2007 PQRI and exchange thoughts on the program related to hospitalists. A concern for hospitalists was the intent for the PQRI to include performance measures for each of the 39 medical specialties recognized by CMS; hospitalists were lumped under general internal medicine. By working closely with CMS and the PCPI, SHM succeeded in achieving denominator specification changes for additional relevant measures to become available for hospitalist reporting through the 2007 PQRI.

Soon thereafter, the CMS Final Rule on Physician Payment was released, indicating that 10 of the 11 measures available for hospitalist reporting in the 2007 PQRI also were to be included for 2008. “Beta-blocker on Arrival for Acute Myocardial Infarction” was the one measure no longer part of the 2008 PQRI. One new measure available for hospitalist reporting in 2008 is measure No. 75, “Prevention of Ventilator-Associated Pneumonia—Head Elevation,” for which hospitalists can report using a critical care code.

The 2007 PQRI included the following measures on which hospitalists could report:

• No. 5: “Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)”;
• No. 6: “Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease”;
• No. 7: “Beta-blocker Therapy for CAD Patients with Prior Myocardial Infarction”;
• No. 29: “Beta-blocker at Time of Arrival for Acute Myocardial Infarction”;
• No. 31: “Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis”;
• No. 32: “Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy”;
• No. 33: “Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge”;
• No. 34: “Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator Considered”;
• No. 35: “Stroke and Stroke Rehabilitation: Screening for Dysphagia”;
• No. 36: “Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services”; and
• No. 47: “Documentation of an Advanced Care Plan.”

After the final specifications for the 2008 PQRI were released, there was a proposal for denominator specification changes that would preclude inpatient reporting for many of the measures relevant and available to hospitalists in 2007. The PSC again worked closely with the PCPI and relevant professional organizations to preserve the measure specifications for the 2008 PQRI to allow inpatient and thus hospitalist reporting. This experience has further enhanced productive SHM relationships with the PCPI and CMS.

The PSC has an ongoing commitment to recommend SHM members for appointments to PCPI expert measure workgroups, depending on the topic. For example, SHM was recently asked to identify a member to join a newly forming asthma measures workgroup that will be looking to develop inpatient measures. SHM will be notified when a palliative care measures workgroup is being formed.

Senior staff and leadership will meet PCPI senior staff to discuss formation of an expert workgroup on care transitions measures. This work group will be co-chaired by SHM and the American College of Physicians (ACP) and include societies such as the Society of General Internal Medicine (SGIM), the American Geriatrics Society (AGS), and others engaged in the development of the transitions of care consensus document in summer 2007. The work group also will refer to the principles and standards that resulted from the ABIM Foundation’s Stepping Up to the Plate (SUTTP) Alliance as a resource in its development of measures.

Looking ahead to the 2009 PQRI, the PSC has requested measure specification changes to the following PQRI measures:

• No. 56: “Vital Signs for Community Acquired Pneumonia”;
• No. 57: “Oxygenation Assessment for Community Acquired Pneumonia”;
• No. 58: “Assessment of Mental Status for Community Acquired Pneumonia”; and
• No. 59: “Empiric Antibiotic for Community Acquired Pneumonia.”

These measures harmonize with the Joint Commission’s core measures and are relevant for hospitalist performance reporting.

With the NQF

On Sept. 26-28, PSC member Greg Seymann represented SHM at NQF’s 8th Annual Meeting in Washington, D.C. This meeting featured plenary sessions focusing on issues at the forefront of policy discussions related to quality of care including:  

• Chronic care episodes across care settings;
• Medications and quality;
• Medicare performance monitoring and payment initiatives;
• Moving performance measures into electronic health record requirements; and
• Nursing leadership in measurement activities and achieving higher performance.
• In the first quarter of 2008, the PSC has:
• Reviewed and commented on NQF’s “National Voluntary Consensus Standards for Hospital Care: Additional Priorities–2007, Part 2”;
• Sent a representative to the steering committee for the National Voluntary Consensus Clinician-Level Perioperative Care Standards meeting;
• Submitted nominees for the National Voluntary Consensus Standards for Emergency Care Phase II steering committee and the Prevention and Management of Stroke Across the Continuum steering committee (our nominee was accepted for the latter);
• Reviewed and commented on the National Voluntary Consensus Standards for Prevent­­ion and
• Care of Venous Thromboembolism: Performance Measures/Phase II; and;
• Has sent senior leadership and staff to the NQF Spring Meeting and Implementation Conference on Care Coordination.

In the Works

The PSC and the HQPSC submitted a comment letter on CMS’ selection of hospital-acquired conditions and present on admission indicator reporting for 2009. SHM supported CMS’ efforts to improve the quality of care for hospitalized patients by preventing avoidable hospital-acquired conditions and outlining its concerns regarding unintended consequences as relates to the various conditions.

With its new status as the PSC, this enthusiastic and committed group is preparing to extend its mission and scope of work in 2008.

The PSC plans to restructure and serve as expert liaisons for internal and external activities. This not only will empower committee members to become more engaged in our performance agenda, but also allow them to serve as key contacts for staff when monitoring the ever-growing landscape of performance measurement, quality, and policy. TH

In spring 2006 SHM leadership agreed that there was a need to develop a coordinated approach to working with external organizations in the performance and standards quality arena, while collaborating with public policy and educational efforts in this area. To this end, I was hired as the SHM Senior Advisor for Quality Standards and Compliance. At around the same time, leaders from the Public Policy Committee (PPC) and Health Quality Patient Safety (HQPS) Committee joined to form a Performance and Standards Task Force (PSTF).

Purpose of the Task Force

Chaired by Patrick Torcson, MD, the PSTF works with staff to monitor the performance and quality landscape at national organizations charged with the measure development and consensus-building processes, as well as to outreach and develop liaison relationships with other professional medical societies and organizations. Ultimately, the task force wants to create a performance framework unique to and reflective of hospitalists.

Since its inception in the late spring, the PSTF has had several meetings to discuss which organizations SHM should engage with and at what level. In several cases, task force members agreed that an official member liaison should be appointed to serve as SHM’s representative to a particular organization. This serves the purpose of having a clinical expert resource available to staff with regard to the particular activities of each organization, as well as to create a consistent and reliable “SHM face” for a particular organization.

Performance Measures

SHM joined the AMA Physician Consortium for Performance Improvement (PCPI), which works with medical specialty organizations to develop physician-level performance measures. As a new member of the PCPI, SHM submitted feedback during the public comment period on perioperative care measures, the development of which was led by the American College of Surgeons, along with input from other medical specialties. SHM also participated in two expert workgroups this past summer, one on emergency medicine, focusing on treating MI and pneumonia, and another on geriatrics, which focused on falls, urinary incontinence, advanced-care planning as part of end-of-life care, and medication reconciliation as part of care coordination. Both the geriatrics and the emergency medicine measures have been released for public comment. At least through 2006, the PCPI is focusing on measures that fall under the Centers for Medicare and Medicaid Services (CMS) contract and will be included in the Physician Voluntary Reporting Program (PVRP).

The PSTF is actively recruiting leaders to participate in expert workgroups that were convened in November for both outpatient parenteral antimicrobial therapy and anesthesiology topics: perioperative normothermia and critical care. The task force will continue to evaluate the PCPI workgroups to determine which ones it should appoint members to participate in, depending on the topic area.

SHM has also become an organizational member of the National Quality Forum (NQF), a nonprofit organization that Congress, in early July, charged with endorsing consensus-based national standards for measurement and public reporting of healthcare performance data. At around the same time, NQF was seeking nominations for members of the steering committee and technical advisory panels that will oversee the work on the development of new consensus standards for hospital care. This project, sponsored by the Agency for Healthcare Research and Quality (AHRQ), will address patient safety, pediatrics, and inpatient care. The Society hopes to be fully engaged in this initiative.

In mid-October, NQF will hold its 7th Annual Meeting, a National Policy Conference on Quality, at the Grand Hyatt in Washington, D.C. This meeting will feature plenary sessions that focus on issues at the forefront of policy discussions, including incentivizing healthcare quality improvement, the role of policymakers, ways to lead professional and trade associations in improving healthcare quality, and efforts presently underway in the federal government to foster healthcare improvements. Mark Williams, MD, editor in chief of the Journal of Hospital Medicine and SHM member, will attend the policy conference as the SHM representative.

Quality Care Liaisons

In addition to fostering liaisons with organizations like PCPI and NQF, the PSTF has discussed the importance of exploring relationships with other groups, including CMS, the American College of Physicians (ACP), the Ambulatory Quality Care Alliance (AQA), and others engaged in the quality care arena.

In late spring 2006 several SHM members and staff met with CMS to discuss its PVRP in relation to hospitalists. While SHM has endorsed the PVRP, recommending that hospitalists register their intent to report and begin reporting on relevant performance measures to the extent practicable, it is clear that the 16 measures used in the PVRP have limited relevance for hospitalists because most measures used for internal medicine deal with services provided in the ambulatory setting.

Specifically, only two of the 16 measures apply to services billed by hospitalists and those only on a limited basis: aspirin on arrival for myocardial infarction and beta-blocker on arrival for MI have G-codes that can be used with the evaluation and management codes appropriate for hospitalists. In its follow-up letter to CMS staff thanking them for their time, SHM leadership also included recommendations that would expand the current number of PVRP measures that hospitalists could report on from two measures to seven.

SHM has also shared the above quality and performance improvement agenda with the staff of the ACP as well as their quality subcommittee, who have found it to be “well-reasoned and straightforward.” We anticipate having more in-depth discussions with the ACP as our quality agenda evolves.

In August, the Ambulatory Care Quality Alliance (AQA) and the Hospital Quality Alliance (HQA) joined forces to form a Quality Steering Committee in order to better coordinate the promotion of quality measurement, transparency, and improvement in care across hospital and ambulatory care settings. The PSTF is currently pursuing participation in one of the new AQA/HQA workgroups created by the steering committee, which would focus on harmonization of measures across settings.

SHM staff have also reached out to the Society of Critical Care Medicine, the Joint Commission on Accreditation of Healthcare Organizations, and the American Hospital Association to ascertain what these groups are doing in terms of quality and measure development, as well as to see how to align our efforts more closely.

In its work with all of these groups, the task force endeavors to ensure the development of performance measures that more accurately reflect services provided by hospitalists.

2007 Goals

The HQPS has developed a mechanism whereby they review measures proposed by a variety of organizations in order to evaluate which measures are relevant to individual clinicians as compared with institutional measures. It is PSTF’s goal (in conjunction with the HQPS, the PPC, and others) to recommend to the SHM board of directors which physician-level disease-specific measures are relevant to individual hospitalists and to identify where the gaps are. It hopes then to influence the scope of development of care coordination and other hospital-level measures that are in the pipeline, whether working through groups like the PCPI by taking the lead on an expert workgroup, by using the NQF consensus-building process, or by forming other key partnerships with groups like those noted above. It is likely that this work will be accomplished by some combination of these strategies.

Stay tuned for next month’s “SHM Behind the Scenes” by SHM Senior Vice President Joe Miller.

Epstein is the senior advisor for Standards and Compliance at SHM.

2005-2006 Survey Factoid

Use of PAs and NPs in hospital medicine groups

• Thirty percent of all hospital medicine groups (HMGs) employ nurse practitioners (NPs) and physician assistants (PAs).
• Those groups, on average, have 11.2 physicians and 2.8 NPs/PAs. The 70% of groups without NPs/PAs average 7.9 physicians per group.
• The following types of groups are more likely to employ NPs/PAs: academic programs, groups in the eastern U.S., and groups more than 5 years old.
• The frequency with which NPs/PAs perform certain functions in HMGs is summarized in this table:

NP/PA Function - % of HMGs

• Round daily on hospitalized patients - 83%
• Write prescriptions for patients - 82%
• Perform H & Ps upon admission - 77%
• Act as initial responder (consults, admits) - 66%
• Participate in discharge planning - 66%
• Order specialty consultations - 53%
• Assist in teaching students - 33%
• Night or weekend call - 30%
• Post discharge follow-up calls - 20%
• Emergency response; Code Blue - 14%
• Perform invasive procedures - 11%

Source: SHM’s 2005-2006 “Biannual State of the Hospital Medicine Movement” survey.

In spring 2006 SHM leadership agreed that there was a need to develop a coordinated approach to working with external organizations in the performance and standards quality arena, while collaborating with public policy and educational efforts in this area. To this end, I was hired as the SHM Senior Advisor for Quality Standards and Compliance. At around the same time, leaders from the Public Policy Committee (PPC) and Health Quality Patient Safety (HQPS) Committee joined to form a Performance and Standards Task Force (PSTF).

Purpose of the Task Force

Chaired by Patrick Torcson, MD, the PSTF works with staff to monitor the performance and quality landscape at national organizations charged with the measure development and consensus-building processes, as well as to outreach and develop liaison relationships with other professional medical societies and organizations. Ultimately, the task force wants to create a performance framework unique to and reflective of hospitalists.

Since its inception in the late spring, the PSTF has had several meetings to discuss which organizations SHM should engage with and at what level. In several cases, task force members agreed that an official member liaison should be appointed to serve as SHM’s representative to a particular organization. This serves the purpose of having a clinical expert resource available to staff with regard to the particular activities of each organization, as well as to create a consistent and reliable “SHM face” for a particular organization.

Performance Measures

SHM joined the AMA Physician Consortium for Performance Improvement (PCPI), which works with medical specialty organizations to develop physician-level performance measures. As a new member of the PCPI, SHM submitted feedback during the public comment period on perioperative care measures, the development of which was led by the American College of Surgeons, along with input from other medical specialties. SHM also participated in two expert workgroups this past summer, one on emergency medicine, focusing on treating MI and pneumonia, and another on geriatrics, which focused on falls, urinary incontinence, advanced-care planning as part of end-of-life care, and medication reconciliation as part of care coordination. Both the geriatrics and the emergency medicine measures have been released for public comment. At least through 2006, the PCPI is focusing on measures that fall under the Centers for Medicare and Medicaid Services (CMS) contract and will be included in the Physician Voluntary Reporting Program (PVRP).

The PSTF is actively recruiting leaders to participate in expert workgroups that were convened in November for both outpatient parenteral antimicrobial therapy and anesthesiology topics: perioperative normothermia and critical care. The task force will continue to evaluate the PCPI workgroups to determine which ones it should appoint members to participate in, depending on the topic area.

SHM has also become an organizational member of the National Quality Forum (NQF), a nonprofit organization that Congress, in early July, charged with endorsing consensus-based national standards for measurement and public reporting of healthcare performance data. At around the same time, NQF was seeking nominations for members of the steering committee and technical advisory panels that will oversee the work on the development of new consensus standards for hospital care. This project, sponsored by the Agency for Healthcare Research and Quality (AHRQ), will address patient safety, pediatrics, and inpatient care. The Society hopes to be fully engaged in this initiative.

In mid-October, NQF will hold its 7th Annual Meeting, a National Policy Conference on Quality, at the Grand Hyatt in Washington, D.C. This meeting will feature plenary sessions that focus on issues at the forefront of policy discussions, including incentivizing healthcare quality improvement, the role of policymakers, ways to lead professional and trade associations in improving healthcare quality, and efforts presently underway in the federal government to foster healthcare improvements. Mark Williams, MD, editor in chief of the Journal of Hospital Medicine and SHM member, will attend the policy conference as the SHM representative.

Quality Care Liaisons

In addition to fostering liaisons with organizations like PCPI and NQF, the PSTF has discussed the importance of exploring relationships with other groups, including CMS, the American College of Physicians (ACP), the Ambulatory Quality Care Alliance (AQA), and others engaged in the quality care arena.

In late spring 2006 several SHM members and staff met with CMS to discuss its PVRP in relation to hospitalists. While SHM has endorsed the PVRP, recommending that hospitalists register their intent to report and begin reporting on relevant performance measures to the extent practicable, it is clear that the 16 measures used in the PVRP have limited relevance for hospitalists because most measures used for internal medicine deal with services provided in the ambulatory setting.

Specifically, only two of the 16 measures apply to services billed by hospitalists and those only on a limited basis: aspirin on arrival for myocardial infarction and beta-blocker on arrival for MI have G-codes that can be used with the evaluation and management codes appropriate for hospitalists. In its follow-up letter to CMS staff thanking them for their time, SHM leadership also included recommendations that would expand the current number of PVRP measures that hospitalists could report on from two measures to seven.

SHM has also shared the above quality and performance improvement agenda with the staff of the ACP as well as their quality subcommittee, who have found it to be “well-reasoned and straightforward.” We anticipate having more in-depth discussions with the ACP as our quality agenda evolves.

In August, the Ambulatory Care Quality Alliance (AQA) and the Hospital Quality Alliance (HQA) joined forces to form a Quality Steering Committee in order to better coordinate the promotion of quality measurement, transparency, and improvement in care across hospital and ambulatory care settings. The PSTF is currently pursuing participation in one of the new AQA/HQA workgroups created by the steering committee, which would focus on harmonization of measures across settings.

SHM staff have also reached out to the Society of Critical Care Medicine, the Joint Commission on Accreditation of Healthcare Organizations, and the American Hospital Association to ascertain what these groups are doing in terms of quality and measure development, as well as to see how to align our efforts more closely.

In its work with all of these groups, the task force endeavors to ensure the development of performance measures that more accurately reflect services provided by hospitalists.

2007 Goals

The HQPS has developed a mechanism whereby they review measures proposed by a variety of organizations in order to evaluate which measures are relevant to individual clinicians as compared with institutional measures. It is PSTF’s goal (in conjunction with the HQPS, the PPC, and others) to recommend to the SHM board of directors which physician-level disease-specific measures are relevant to individual hospitalists and to identify where the gaps are. It hopes then to influence the scope of development of care coordination and other hospital-level measures that are in the pipeline, whether working through groups like the PCPI by taking the lead on an expert workgroup, by using the NQF consensus-building process, or by forming other key partnerships with groups like those noted above. It is likely that this work will be accomplished by some combination of these strategies.

Stay tuned for next month’s “SHM Behind the Scenes” by SHM Senior Vice President Joe Miller.

Epstein is the senior advisor for Standards and Compliance at SHM.

2005-2006 Survey Factoid

Use of PAs and NPs in hospital medicine groups

• Thirty percent of all hospital medicine groups (HMGs) employ nurse practitioners (NPs) and physician assistants (PAs).
• Those groups, on average, have 11.2 physicians and 2.8 NPs/PAs. The 70% of groups without NPs/PAs average 7.9 physicians per group.
• The following types of groups are more likely to employ NPs/PAs: academic programs, groups in the eastern U.S., and groups more than 5 years old.
• The frequency with which NPs/PAs perform certain functions in HMGs is summarized in this table:

NP/PA Function - % of HMGs

• Round daily on hospitalized patients - 83%
• Write prescriptions for patients - 82%
• Perform H & Ps upon admission - 77%
• Act as initial responder (consults, admits) - 66%
• Participate in discharge planning - 66%
• Order specialty consultations - 53%
• Assist in teaching students - 33%
• Night or weekend call - 30%
• Post discharge follow-up calls - 20%
• Emergency response; Code Blue - 14%
• Perform invasive procedures - 11%

Source: SHM’s 2005-2006 “Biannual State of the Hospital Medicine Movement” survey.

In spring 2006 SHM leadership agreed that there was a need to develop a coordinated approach to working with external organizations in the performance and standards quality arena, while collaborating with public policy and educational efforts in this area. To this end, I was hired as the SHM Senior Advisor for Quality Standards and Compliance. At around the same time, leaders from the Public Policy Committee (PPC) and Health Quality Patient Safety (HQPS) Committee joined to form a Performance and Standards Task Force (PSTF).

Purpose of the Task Force

Chaired by Patrick Torcson, MD, the PSTF works with staff to monitor the performance and quality landscape at national organizations charged with the measure development and consensus-building processes, as well as to outreach and develop liaison relationships with other professional medical societies and organizations. Ultimately, the task force wants to create a performance framework unique to and reflective of hospitalists.

Since its inception in the late spring, the PSTF has had several meetings to discuss which organizations SHM should engage with and at what level. In several cases, task force members agreed that an official member liaison should be appointed to serve as SHM’s representative to a particular organization. This serves the purpose of having a clinical expert resource available to staff with regard to the particular activities of each organization, as well as to create a consistent and reliable “SHM face” for a particular organization.

Performance Measures

SHM joined the AMA Physician Consortium for Performance Improvement (PCPI), which works with medical specialty organizations to develop physician-level performance measures. As a new member of the PCPI, SHM submitted feedback during the public comment period on perioperative care measures, the development of which was led by the American College of Surgeons, along with input from other medical specialties. SHM also participated in two expert workgroups this past summer, one on emergency medicine, focusing on treating MI and pneumonia, and another on geriatrics, which focused on falls, urinary incontinence, advanced-care planning as part of end-of-life care, and medication reconciliation as part of care coordination. Both the geriatrics and the emergency medicine measures have been released for public comment. At least through 2006, the PCPI is focusing on measures that fall under the Centers for Medicare and Medicaid Services (CMS) contract and will be included in the Physician Voluntary Reporting Program (PVRP).

The PSTF is actively recruiting leaders to participate in expert workgroups that were convened in November for both outpatient parenteral antimicrobial therapy and anesthesiology topics: perioperative normothermia and critical care. The task force will continue to evaluate the PCPI workgroups to determine which ones it should appoint members to participate in, depending on the topic area.

SHM has also become an organizational member of the National Quality Forum (NQF), a nonprofit organization that Congress, in early July, charged with endorsing consensus-based national standards for measurement and public reporting of healthcare performance data. At around the same time, NQF was seeking nominations for members of the steering committee and technical advisory panels that will oversee the work on the development of new consensus standards for hospital care. This project, sponsored by the Agency for Healthcare Research and Quality (AHRQ), will address patient safety, pediatrics, and inpatient care. The Society hopes to be fully engaged in this initiative.

In mid-October, NQF will hold its 7th Annual Meeting, a National Policy Conference on Quality, at the Grand Hyatt in Washington, D.C. This meeting will feature plenary sessions that focus on issues at the forefront of policy discussions, including incentivizing healthcare quality improvement, the role of policymakers, ways to lead professional and trade associations in improving healthcare quality, and efforts presently underway in the federal government to foster healthcare improvements. Mark Williams, MD, editor in chief of the Journal of Hospital Medicine and SHM member, will attend the policy conference as the SHM representative.

Quality Care Liaisons

In addition to fostering liaisons with organizations like PCPI and NQF, the PSTF has discussed the importance of exploring relationships with other groups, including CMS, the American College of Physicians (ACP), the Ambulatory Quality Care Alliance (AQA), and others engaged in the quality care arena.

In late spring 2006 several SHM members and staff met with CMS to discuss its PVRP in relation to hospitalists. While SHM has endorsed the PVRP, recommending that hospitalists register their intent to report and begin reporting on relevant performance measures to the extent practicable, it is clear that the 16 measures used in the PVRP have limited relevance for hospitalists because most measures used for internal medicine deal with services provided in the ambulatory setting.

Specifically, only two of the 16 measures apply to services billed by hospitalists and those only on a limited basis: aspirin on arrival for myocardial infarction and beta-blocker on arrival for MI have G-codes that can be used with the evaluation and management codes appropriate for hospitalists. In its follow-up letter to CMS staff thanking them for their time, SHM leadership also included recommendations that would expand the current number of PVRP measures that hospitalists could report on from two measures to seven.

SHM has also shared the above quality and performance improvement agenda with the staff of the ACP as well as their quality subcommittee, who have found it to be “well-reasoned and straightforward.” We anticipate having more in-depth discussions with the ACP as our quality agenda evolves.

In August, the Ambulatory Care Quality Alliance (AQA) and the Hospital Quality Alliance (HQA) joined forces to form a Quality Steering Committee in order to better coordinate the promotion of quality measurement, transparency, and improvement in care across hospital and ambulatory care settings. The PSTF is currently pursuing participation in one of the new AQA/HQA workgroups created by the steering committee, which would focus on harmonization of measures across settings.

SHM staff have also reached out to the Society of Critical Care Medicine, the Joint Commission on Accreditation of Healthcare Organizations, and the American Hospital Association to ascertain what these groups are doing in terms of quality and measure development, as well as to see how to align our efforts more closely.

In its work with all of these groups, the task force endeavors to ensure the development of performance measures that more accurately reflect services provided by hospitalists.

2007 Goals

The HQPS has developed a mechanism whereby they review measures proposed by a variety of organizations in order to evaluate which measures are relevant to individual clinicians as compared with institutional measures. It is PSTF’s goal (in conjunction with the HQPS, the PPC, and others) to recommend to the SHM board of directors which physician-level disease-specific measures are relevant to individual hospitalists and to identify where the gaps are. It hopes then to influence the scope of development of care coordination and other hospital-level measures that are in the pipeline, whether working through groups like the PCPI by taking the lead on an expert workgroup, by using the NQF consensus-building process, or by forming other key partnerships with groups like those noted above. It is likely that this work will be accomplished by some combination of these strategies.

Stay tuned for next month’s “SHM Behind the Scenes” by SHM Senior Vice President Joe Miller.

Epstein is the senior advisor for Standards and Compliance at SHM.

2005-2006 Survey Factoid

Use of PAs and NPs in hospital medicine groups

• Thirty percent of all hospital medicine groups (HMGs) employ nurse practitioners (NPs) and physician assistants (PAs).
• Those groups, on average, have 11.2 physicians and 2.8 NPs/PAs. The 70% of groups without NPs/PAs average 7.9 physicians per group.
• The following types of groups are more likely to employ NPs/PAs: academic programs, groups in the eastern U.S., and groups more than 5 years old.
• The frequency with which NPs/PAs perform certain functions in HMGs is summarized in this table:

NP/PA Function - % of HMGs

• Round daily on hospitalized patients - 83%
• Write prescriptions for patients - 82%
• Perform H & Ps upon admission - 77%
• Act as initial responder (consults, admits) - 66%
• Participate in discharge planning - 66%
• Order specialty consultations - 53%
• Assist in teaching students - 33%
• Night or weekend call - 30%
• Post discharge follow-up calls - 20%
• Emergency response; Code Blue - 14%
• Perform invasive procedures - 11%

Source: SHM’s 2005-2006 “Biannual State of the Hospital Medicine Movement” survey.

Federal officials are increasingly embracing pay for performance (P4P) in an effort to promote high-quality, cost effective care in government health programs. As the Centers for Medicaid and Medicare Services (CMS) and Congress move forward to implement this concept, SHM is working to ensure that the views of hospitalists are represented in this important debate.

More than 100 P4P programs are already up and running in the private sector in an attempt to reward quality healthcare by setting different payment levels for providers based on how well they meet benchmarks of quality and efficiency. CMS is testing the feasibility of applying this concept to the Medicare program through a number of initiatives.

SHM’s Public Policy and Hospital Quality and Patient Safety committees have been involved in evaluating CMS’ Physician Voluntary Reporting Program (PVRP), launched earlier this year and widely believed to be the precursor to an eventual P4P program for physicians’ services. Under this initiative, physicians are encouraged to submit quality data on a “starter set” of 16 evidence-based measures for certain primary care, surgery, nephrology, and emergency medical services. Physicians who participate in the program receive confidential reports on their performance.

click for large version

SHM has recommended that hospitalists register their intent to report and begin reporting on relevant performance measures to the extent practicable as a way of becoming more familiar with the program. Because these initial 16 measures have only limited relevance to services billed by hospitalists, SHM is engaged in discussions with lawmakers and their staffs, CMS officials, and consensus organizations involved in developing quality measures, to expand the program’s scope.

As part of Advocacy Day on May 3, some 70 SHM members met with legislators and their staffs and conveyed SHM’s support for initiatives like the PVRP that seek to measure resource use and improve quality, to attain better value for the Medicare program. (See coverage in The Hospitalist SHM Meeting Reporter, July 2006, p. 1.) Participants also educated lawmakers on the role of hospitalists in helping their institutions meet quality reporting requirements mandated under the Medicare Modernization Act, which ties annual hospital payment updates to the submission of performance data for 10 quality measures. The participants also expressed SHM’s interest in working with CMS on demonstration projects that assess the contributions of hospital medicine programs to improved patient care and more efficient management of hospital resources.

In addition to Congress and CMS, non-governmental groups such as the National Quality Forum (NQF), the American Medical Association Physician Consortium for Performance Improvement (PCPI), and the Ambulatory Care Quality Alliance are actively engaged in providing input to CMS on the PVRP and other P4P-related initiatives. SHM has joined the PCPI, which works with medical specialty organizations to develop physician-level performance measures.

As a new member of the PCPI, SHM submitted feedback during the public comment period on perioperative care measures, the development of which was led by the American College of Surgeons, along with input from other medical specialties. SHM will also participate in two upcoming workgroups—one on emergency medicine, which will focus on treating for MI and pneumonia, and another on geriatrics, which will look at falls, urinary incontinence, and end-of-life care. At least through 2006, the PCPI is focusing on measures that fall under the CMS contract and will be included in the PVRP.

SHM is also a member of the NQF, a nonprofit organization that Congress has charged with endorsing consensus-based national standards for measurement and public reporting of healthcare performance data. NQF is seeking nominations for members of the steering committee and technical advisory panels that will oversee the work on new consensus standards for hospital care. This project, sponsored by the AHRQ, will address issues of patient safety, pediatrics, and inpatient care. SHM will submit nominations during this process and plans to be fully engaged.

To further develop its agenda on performance and quality standards in inpatient hospital care, SHM recently established a new Performance and Standards Task Force. This task force is charged with developing a coordinated approach for SHM to work with external organizations in the performance and standards and quality arena and comprises the chairs of the PPC and HQPS committees and other SHM leaders active in organizations like the JCAHO and the IHI.

P4P is here to stay. SHM is well positioned to influence the development and implementation of inpatient quality measures that may eventually become part of a Medicare P4P program for physician services. TH

Allendorf is senior advisor for Advocacy and Government Affairs at SHM. Epstein is senior advisor for Quality Standards and Compliance at SHM.

SHM: BEHIND THE SCENES

How SHM Manages Your Money

By Steven Poitras

In the past three months you have read articles from my peers, including one by Todd Von Deak concerning the great strides he is making in the membership department by ensuring that we are generating the most benefits for our members; one from Scott Johnson, who is taking us into the future with regard to information services; and from Geri Barnes, our education and quality initiatives director, who is helping drive our organizational mission of promoting excellence in the practice of hospital medicine.

This month I want to tell you about our organization, its structure, and what we are collectively doing to ensure that the dues and grants we receive are put to good use to benefit our members and ensure our place in driving hospital medicine forward.

Studies show that 70% of small businesses and small non-profit organizations survive their first year, 30% survive their second year, and only 20% survive after five years. SHM will celebrate its 10th year in 2007. Congratulations and thank you. It’s you, our members, who have taken us this far. It’s you, our members, who will take us into the next 10, 20, 50 years, and beyond. We are not the same organization we were 10 years ago, and I suspect we will not be the same organization in 10 years that we are today.

Over the years I have worked and consulted in many organizations ranging from small mom-and-pops to large, multinational corporations. More often than not, despite a common desire to succeed, conflict exists within various constituencies (e.g., employees, executive management, board of directors) that leads to differing opinions on the best strategy for the company moving forward. I’m proud to say that this isn’t the case with SHM.

We have formulated a business model that uses tried-and-true corporate tools to ensure our members receive the maximum possible value in areas of the greatest impact. It encompasses both our paid and non-paid staff and volunteers to validate what matters most. Your dollars are put to good use. We concentrate on doing things that can be done and done well. If it’s a great idea but doesn’t get to the heart of what our members need or want, we won’t siphon off money and time. We receive money from our members and grantors with the intent of fulfilling a promise or mission. We try to understand what can be accomplished, and then we apply our resources to those goals, ensuring that a higher percentage of those resources are going to mission critical programs and services.

Both our members and grantors look for a strong return on their investment for the monies they send and set aside for our cause. Performance standards are necessary, not only to ensure high level delivery of services but also to ensure our organization’s fiscal responsibility. We employ a staff with many qualifications and backgrounds and coordinate our efforts further with diverse, educated, and dedicated volunteers who are experts in their areas.

Not only is our staff concerned with producing measurable results attributed to the dollars we receive, but we are also measuring mission success in numeric terms other than profit and loss, most specifically within our education and quality initiatives as well as our membership departments. Together these departments are spearheading metrics initiatives that are, for the most part, completely new to our organization but essential to our growth. We involve our staff at all levels of the organization in the pursuit of obtaining these metrics. We strive to collaboratively fulfill SHM’s objectives, and our adaptability allows us to scan the external environment and respond to the ever-changing needs of our members and grantors. Consistency of these values and the internal systems from our information services department that support problem solving, efficiency, and effectiveness at every level across our organizational boundaries help us obtain fulfilling our mission.

Communication about our direction is provided at every opportunity: staff meetings, board meetings, brown-bag lunches, and one-on-one employee discussions. Teamwork is emphasized as the primary means for accomplishing work. When decisions need to be made, all employees and volunteers are sought for counsel and advice from them, their peers, and others who might have insight about our programs. Armed with knowledge, strategic and tactical objectives that are clearly defined and pursued with greater focus, conviction, and diligence our employees embrace the change that is so evident in our fast moving organization.

Everyone in our organization understands where we are going, how we intend to get there, and how he or she fits into our organization’s strategy. The culture of our organization has shifted, but our focus on the benefits of hospital medicine has remained constant. By utilizing these strategic planning tools and techniques, we are redeveloping and revitalizing our corporate mission statement by understanding our organizations strengths, weaknesses, opportunities, threats, and actual and potential competitive advantages. This allows us to move beyond just mere expectations to actually setting the standard by which everyone will be judged.

Our employees, volunteers, members, and grantors remind us that while the business is managed on a daily basis, during our strategic planning and project implementation we focus our strategy on the vital few rather than the trivial many. This allows us to put our organization on the right track for survival and long-term growth.

As we grow, we will search harder and further for experts to help us fulfill our promise of setting SHM as the standard in hospital medicine. I encourage your feedback. Please reach me at spoitras@hospitalmedicine.org. You will find that I am always accessible and open to your thoughts and ideas.

Next month you will hear from Laura Allendorf, senior advisor for advocacy and government affairs.

Poitras is director of Business Operations at SHM.

Federal officials are increasingly embracing pay for performance (P4P) in an effort to promote high-quality, cost effective care in government health programs. As the Centers for Medicaid and Medicare Services (CMS) and Congress move forward to implement this concept, SHM is working to ensure that the views of hospitalists are represented in this important debate.

More than 100 P4P programs are already up and running in the private sector in an attempt to reward quality healthcare by setting different payment levels for providers based on how well they meet benchmarks of quality and efficiency. CMS is testing the feasibility of applying this concept to the Medicare program through a number of initiatives.

SHM’s Public Policy and Hospital Quality and Patient Safety committees have been involved in evaluating CMS’ Physician Voluntary Reporting Program (PVRP), launched earlier this year and widely believed to be the precursor to an eventual P4P program for physicians’ services. Under this initiative, physicians are encouraged to submit quality data on a “starter set” of 16 evidence-based measures for certain primary care, surgery, nephrology, and emergency medical services. Physicians who participate in the program receive confidential reports on their performance.

click for large version

SHM has recommended that hospitalists register their intent to report and begin reporting on relevant performance measures to the extent practicable as a way of becoming more familiar with the program. Because these initial 16 measures have only limited relevance to services billed by hospitalists, SHM is engaged in discussions with lawmakers and their staffs, CMS officials, and consensus organizations involved in developing quality measures, to expand the program’s scope.

As part of Advocacy Day on May 3, some 70 SHM members met with legislators and their staffs and conveyed SHM’s support for initiatives like the PVRP that seek to measure resource use and improve quality, to attain better value for the Medicare program. (See coverage in The Hospitalist SHM Meeting Reporter, July 2006, p. 1.) Participants also educated lawmakers on the role of hospitalists in helping their institutions meet quality reporting requirements mandated under the Medicare Modernization Act, which ties annual hospital payment updates to the submission of performance data for 10 quality measures. The participants also expressed SHM’s interest in working with CMS on demonstration projects that assess the contributions of hospital medicine programs to improved patient care and more efficient management of hospital resources.

In addition to Congress and CMS, non-governmental groups such as the National Quality Forum (NQF), the American Medical Association Physician Consortium for Performance Improvement (PCPI), and the Ambulatory Care Quality Alliance are actively engaged in providing input to CMS on the PVRP and other P4P-related initiatives. SHM has joined the PCPI, which works with medical specialty organizations to develop physician-level performance measures.

As a new member of the PCPI, SHM submitted feedback during the public comment period on perioperative care measures, the development of which was led by the American College of Surgeons, along with input from other medical specialties. SHM will also participate in two upcoming workgroups—one on emergency medicine, which will focus on treating for MI and pneumonia, and another on geriatrics, which will look at falls, urinary incontinence, and end-of-life care. At least through 2006, the PCPI is focusing on measures that fall under the CMS contract and will be included in the PVRP.

SHM is also a member of the NQF, a nonprofit organization that Congress has charged with endorsing consensus-based national standards for measurement and public reporting of healthcare performance data. NQF is seeking nominations for members of the steering committee and technical advisory panels that will oversee the work on new consensus standards for hospital care. This project, sponsored by the AHRQ, will address issues of patient safety, pediatrics, and inpatient care. SHM will submit nominations during this process and plans to be fully engaged.

To further develop its agenda on performance and quality standards in inpatient hospital care, SHM recently established a new Performance and Standards Task Force. This task force is charged with developing a coordinated approach for SHM to work with external organizations in the performance and standards and quality arena and comprises the chairs of the PPC and HQPS committees and other SHM leaders active in organizations like the JCAHO and the IHI.

P4P is here to stay. SHM is well positioned to influence the development and implementation of inpatient quality measures that may eventually become part of a Medicare P4P program for physician services. TH

Allendorf is senior advisor for Advocacy and Government Affairs at SHM. Epstein is senior advisor for Quality Standards and Compliance at SHM.

SHM: BEHIND THE SCENES

How SHM Manages Your Money

By Steven Poitras

In the past three months you have read articles from my peers, including one by Todd Von Deak concerning the great strides he is making in the membership department by ensuring that we are generating the most benefits for our members; one from Scott Johnson, who is taking us into the future with regard to information services; and from Geri Barnes, our education and quality initiatives director, who is helping drive our organizational mission of promoting excellence in the practice of hospital medicine.

This month I want to tell you about our organization, its structure, and what we are collectively doing to ensure that the dues and grants we receive are put to good use to benefit our members and ensure our place in driving hospital medicine forward.

Studies show that 70% of small businesses and small non-profit organizations survive their first year, 30% survive their second year, and only 20% survive after five years. SHM will celebrate its 10th year in 2007. Congratulations and thank you. It’s you, our members, who have taken us this far. It’s you, our members, who will take us into the next 10, 20, 50 years, and beyond. We are not the same organization we were 10 years ago, and I suspect we will not be the same organization in 10 years that we are today.

Over the years I have worked and consulted in many organizations ranging from small mom-and-pops to large, multinational corporations. More often than not, despite a common desire to succeed, conflict exists within various constituencies (e.g., employees, executive management, board of directors) that leads to differing opinions on the best strategy for the company moving forward. I’m proud to say that this isn’t the case with SHM.

We have formulated a business model that uses tried-and-true corporate tools to ensure our members receive the maximum possible value in areas of the greatest impact. It encompasses both our paid and non-paid staff and volunteers to validate what matters most. Your dollars are put to good use. We concentrate on doing things that can be done and done well. If it’s a great idea but doesn’t get to the heart of what our members need or want, we won’t siphon off money and time. We receive money from our members and grantors with the intent of fulfilling a promise or mission. We try to understand what can be accomplished, and then we apply our resources to those goals, ensuring that a higher percentage of those resources are going to mission critical programs and services.

Both our members and grantors look for a strong return on their investment for the monies they send and set aside for our cause. Performance standards are necessary, not only to ensure high level delivery of services but also to ensure our organization’s fiscal responsibility. We employ a staff with many qualifications and backgrounds and coordinate our efforts further with diverse, educated, and dedicated volunteers who are experts in their areas.

Not only is our staff concerned with producing measurable results attributed to the dollars we receive, but we are also measuring mission success in numeric terms other than profit and loss, most specifically within our education and quality initiatives as well as our membership departments. Together these departments are spearheading metrics initiatives that are, for the most part, completely new to our organization but essential to our growth. We involve our staff at all levels of the organization in the pursuit of obtaining these metrics. We strive to collaboratively fulfill SHM’s objectives, and our adaptability allows us to scan the external environment and respond to the ever-changing needs of our members and grantors. Consistency of these values and the internal systems from our information services department that support problem solving, efficiency, and effectiveness at every level across our organizational boundaries help us obtain fulfilling our mission.

Communication about our direction is provided at every opportunity: staff meetings, board meetings, brown-bag lunches, and one-on-one employee discussions. Teamwork is emphasized as the primary means for accomplishing work. When decisions need to be made, all employees and volunteers are sought for counsel and advice from them, their peers, and others who might have insight about our programs. Armed with knowledge, strategic and tactical objectives that are clearly defined and pursued with greater focus, conviction, and diligence our employees embrace the change that is so evident in our fast moving organization.

Everyone in our organization understands where we are going, how we intend to get there, and how he or she fits into our organization’s strategy. The culture of our organization has shifted, but our focus on the benefits of hospital medicine has remained constant. By utilizing these strategic planning tools and techniques, we are redeveloping and revitalizing our corporate mission statement by understanding our organizations strengths, weaknesses, opportunities, threats, and actual and potential competitive advantages. This allows us to move beyond just mere expectations to actually setting the standard by which everyone will be judged.

Our employees, volunteers, members, and grantors remind us that while the business is managed on a daily basis, during our strategic planning and project implementation we focus our strategy on the vital few rather than the trivial many. This allows us to put our organization on the right track for survival and long-term growth.

As we grow, we will search harder and further for experts to help us fulfill our promise of setting SHM as the standard in hospital medicine. I encourage your feedback. Please reach me at spoitras@hospitalmedicine.org. You will find that I am always accessible and open to your thoughts and ideas.

Next month you will hear from Laura Allendorf, senior advisor for advocacy and government affairs.

Poitras is director of Business Operations at SHM.

Federal officials are increasingly embracing pay for performance (P4P) in an effort to promote high-quality, cost effective care in government health programs. As the Centers for Medicaid and Medicare Services (CMS) and Congress move forward to implement this concept, SHM is working to ensure that the views of hospitalists are represented in this important debate.

More than 100 P4P programs are already up and running in the private sector in an attempt to reward quality healthcare by setting different payment levels for providers based on how well they meet benchmarks of quality and efficiency. CMS is testing the feasibility of applying this concept to the Medicare program through a number of initiatives.

SHM’s Public Policy and Hospital Quality and Patient Safety committees have been involved in evaluating CMS’ Physician Voluntary Reporting Program (PVRP), launched earlier this year and widely believed to be the precursor to an eventual P4P program for physicians’ services. Under this initiative, physicians are encouraged to submit quality data on a “starter set” of 16 evidence-based measures for certain primary care, surgery, nephrology, and emergency medical services. Physicians who participate in the program receive confidential reports on their performance.

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SHM has recommended that hospitalists register their intent to report and begin reporting on relevant performance measures to the extent practicable as a way of becoming more familiar with the program. Because these initial 16 measures have only limited relevance to services billed by hospitalists, SHM is engaged in discussions with lawmakers and their staffs, CMS officials, and consensus organizations involved in developing quality measures, to expand the program’s scope.

As part of Advocacy Day on May 3, some 70 SHM members met with legislators and their staffs and conveyed SHM’s support for initiatives like the PVRP that seek to measure resource use and improve quality, to attain better value for the Medicare program. (See coverage in The Hospitalist SHM Meeting Reporter, July 2006, p. 1.) Participants also educated lawmakers on the role of hospitalists in helping their institutions meet quality reporting requirements mandated under the Medicare Modernization Act, which ties annual hospital payment updates to the submission of performance data for 10 quality measures. The participants also expressed SHM’s interest in working with CMS on demonstration projects that assess the contributions of hospital medicine programs to improved patient care and more efficient management of hospital resources.

In addition to Congress and CMS, non-governmental groups such as the National Quality Forum (NQF), the American Medical Association Physician Consortium for Performance Improvement (PCPI), and the Ambulatory Care Quality Alliance are actively engaged in providing input to CMS on the PVRP and other P4P-related initiatives. SHM has joined the PCPI, which works with medical specialty organizations to develop physician-level performance measures.

As a new member of the PCPI, SHM submitted feedback during the public comment period on perioperative care measures, the development of which was led by the American College of Surgeons, along with input from other medical specialties. SHM will also participate in two upcoming workgroups—one on emergency medicine, which will focus on treating for MI and pneumonia, and another on geriatrics, which will look at falls, urinary incontinence, and end-of-life care. At least through 2006, the PCPI is focusing on measures that fall under the CMS contract and will be included in the PVRP.

SHM is also a member of the NQF, a nonprofit organization that Congress has charged with endorsing consensus-based national standards for measurement and public reporting of healthcare performance data. NQF is seeking nominations for members of the steering committee and technical advisory panels that will oversee the work on new consensus standards for hospital care. This project, sponsored by the AHRQ, will address issues of patient safety, pediatrics, and inpatient care. SHM will submit nominations during this process and plans to be fully engaged.

To further develop its agenda on performance and quality standards in inpatient hospital care, SHM recently established a new Performance and Standards Task Force. This task force is charged with developing a coordinated approach for SHM to work with external organizations in the performance and standards and quality arena and comprises the chairs of the PPC and HQPS committees and other SHM leaders active in organizations like the JCAHO and the IHI.

P4P is here to stay. SHM is well positioned to influence the development and implementation of inpatient quality measures that may eventually become part of a Medicare P4P program for physician services. TH

Allendorf is senior advisor for Advocacy and Government Affairs at SHM. Epstein is senior advisor for Quality Standards and Compliance at SHM.

SHM: BEHIND THE SCENES

How SHM Manages Your Money

By Steven Poitras

In the past three months you have read articles from my peers, including one by Todd Von Deak concerning the great strides he is making in the membership department by ensuring that we are generating the most benefits for our members; one from Scott Johnson, who is taking us into the future with regard to information services; and from Geri Barnes, our education and quality initiatives director, who is helping drive our organizational mission of promoting excellence in the practice of hospital medicine.

This month I want to tell you about our organization, its structure, and what we are collectively doing to ensure that the dues and grants we receive are put to good use to benefit our members and ensure our place in driving hospital medicine forward.

Studies show that 70% of small businesses and small non-profit organizations survive their first year, 30% survive their second year, and only 20% survive after five years. SHM will celebrate its 10th year in 2007. Congratulations and thank you. It’s you, our members, who have taken us this far. It’s you, our members, who will take us into the next 10, 20, 50 years, and beyond. We are not the same organization we were 10 years ago, and I suspect we will not be the same organization in 10 years that we are today.

Over the years I have worked and consulted in many organizations ranging from small mom-and-pops to large, multinational corporations. More often than not, despite a common desire to succeed, conflict exists within various constituencies (e.g., employees, executive management, board of directors) that leads to differing opinions on the best strategy for the company moving forward. I’m proud to say that this isn’t the case with SHM.

We have formulated a business model that uses tried-and-true corporate tools to ensure our members receive the maximum possible value in areas of the greatest impact. It encompasses both our paid and non-paid staff and volunteers to validate what matters most. Your dollars are put to good use. We concentrate on doing things that can be done and done well. If it’s a great idea but doesn’t get to the heart of what our members need or want, we won’t siphon off money and time. We receive money from our members and grantors with the intent of fulfilling a promise or mission. We try to understand what can be accomplished, and then we apply our resources to those goals, ensuring that a higher percentage of those resources are going to mission critical programs and services.

Both our members and grantors look for a strong return on their investment for the monies they send and set aside for our cause. Performance standards are necessary, not only to ensure high level delivery of services but also to ensure our organization’s fiscal responsibility. We employ a staff with many qualifications and backgrounds and coordinate our efforts further with diverse, educated, and dedicated volunteers who are experts in their areas.

Not only is our staff concerned with producing measurable results attributed to the dollars we receive, but we are also measuring mission success in numeric terms other than profit and loss, most specifically within our education and quality initiatives as well as our membership departments. Together these departments are spearheading metrics initiatives that are, for the most part, completely new to our organization but essential to our growth. We involve our staff at all levels of the organization in the pursuit of obtaining these metrics. We strive to collaboratively fulfill SHM’s objectives, and our adaptability allows us to scan the external environment and respond to the ever-changing needs of our members and grantors. Consistency of these values and the internal systems from our information services department that support problem solving, efficiency, and effectiveness at every level across our organizational boundaries help us obtain fulfilling our mission.

Communication about our direction is provided at every opportunity: staff meetings, board meetings, brown-bag lunches, and one-on-one employee discussions. Teamwork is emphasized as the primary means for accomplishing work. When decisions need to be made, all employees and volunteers are sought for counsel and advice from them, their peers, and others who might have insight about our programs. Armed with knowledge, strategic and tactical objectives that are clearly defined and pursued with greater focus, conviction, and diligence our employees embrace the change that is so evident in our fast moving organization.

Everyone in our organization understands where we are going, how we intend to get there, and how he or she fits into our organization’s strategy. The culture of our organization has shifted, but our focus on the benefits of hospital medicine has remained constant. By utilizing these strategic planning tools and techniques, we are redeveloping and revitalizing our corporate mission statement by understanding our organizations strengths, weaknesses, opportunities, threats, and actual and potential competitive advantages. This allows us to move beyond just mere expectations to actually setting the standard by which everyone will be judged.

Our employees, volunteers, members, and grantors remind us that while the business is managed on a daily basis, during our strategic planning and project implementation we focus our strategy on the vital few rather than the trivial many. This allows us to put our organization on the right track for survival and long-term growth.

As we grow, we will search harder and further for experts to help us fulfill our promise of setting SHM as the standard in hospital medicine. I encourage your feedback. Please reach me at spoitras@hospitalmedicine.org. You will find that I am always accessible and open to your thoughts and ideas.

Next month you will hear from Laura Allendorf, senior advisor for advocacy and government affairs.

Poitras is director of Business Operations at SHM.