Can your cath lab certify that it is ahead of the curve in meeting appropriate care standards? Have you or anyone on your cath lab team considered getting third party validation to prove medical necessity in all cases? And, as with any strategic plan, how do you provide data to all hospital stakeholders that your lab is meeting national standards? How do you engage your physicians to create documentation that paints a true picture of the care being provided?
With accountable care on the horizon, how do we prove our processes under the scrutiny of Recovery Audit Contractors (RACs) and other regulatory bodies? How do we demonstrate to communities we serve that patients are receiving the highest quality care? These are issues all cath labs grapple with today. At Spectrum Health, we expected the Accreditation for Cardiovacular Excellence (ACE) accreditation process would provide the following three benefits: a process to improve case review, a comprehensive evaluation without insider bias, and a focus on issues at the top of physicians’ minds.
As a cath lab manager at Spectrum Health, I was immersed in the ACE accreditation process. The front-end work was significant and required help from our CNS, medical director and quality department to complete all the submission requirements. However, the work done at the beginning added value to the on-site visit and greater meaning to the action plan provided by ACE.
What did we find? We were surprised to uncover gaps between physician documentation of clinical care and quality abstraction; this disconnect was revealed and quantified during our ACE review. The reality of value-based purchasing is here and the ACE review process can help mitigate that risk and cost to your organization. We found the cost of ACE accreditation was warranted by reducing our exposure to paybacks or penalties.
Below, we share our experiences, reasons and benefits that we believe demonstrate the importance and value of ACE’s thorough accreditation procedure.
Why ACE accreditation must be included in your 2013 cath lab budget
Benefit 1. ACE accreditation program will elevate your cath lab performance in documenting appropriate care.
No matter how well you think your cath lab is performing, ACE provides quality metrics, resources and direction that will lead to improved performance and best practices. For example, ACE recently delivered a new toolkit from the Society for Cardiovascular Angiography and Interventions (SCAI). The physician enters the patient data and it responds with the interventions that are medically necessary. This helps the physician reduce risk by documenting clinically appropriate care in a format understood by auditors.
Benefit 2. The ACE accreditation program is more focused than other accreditation programs.
The ACE program is very in-depth because it takes such a close look at a specific component of patient care. The online application process is the first step. The ACE team worked with our cath lab team to guide us through the process. Once the application was complete, the ACE physicians and nurses visited our cath lab. The knowledge and experience displayed in our program evaluation by the reviewers was impressive. They tailored their feedback specifically to the needs of our cath lab team, and gave us several different options with realistic solutions. This was a consultative approach unmatched by other accreditation experiences. We are only partially through our two-year cycle of accreditation, yet ACE continues to discuss our data, progress, and provide us with updates such as the new tool kit from SCAI. The ongoing level of support is valuable to us: we can’t attend every meeting or review all the changes in standards of care. We have experienced a dynamic process that does not end with the accreditation. ACE works with us to be sure we are up to date on all the quality indicators used to measure medical appropriateness. ACE focuses the review on percutaneous coronary intervention (PCI) services that are critical to our business. As pay for performance grows, ensuring accuracy in documenting quality and best practice is critical to the bottom line.
Benefit 3. ACE engages physicians, gives them a focal point for cultural change, driving consensus and collaboration.
ACE cultivates physician collaboration and engagement with options and suggestions generated through peer-to-peer discussion with ACE experts. ACE provides external peer review through impartial case reviews, partnering with recognized leaders in interventional cardiology. Peer review with impartial experts assists in better understanding the relationship between quality and clinical work, and how leadership is directing care. I have found these learning opportunities to be highly effective, as evidenced by a continuing random case review at our facility and greater standardization of policy to drive best practices. I would stress that a physician champion is critical to the process, due to the extensive review of procedural documentation and appropriate care.
(Unexpected) Benefit 4. ACE accreditation helps build relationships with hospital leadership and the quality department.
The ACE accreditation process gave us the value of an outside perspective; it allowed us the opportunity to self-reflect and expand our collaboration with our quality peers. The review we received was direct, accurate and meaningful to our clinical team and quality department. We had fallen into a pattern of “no news is good news” with our quality partners. The accreditation process shed light on many of the challenges the abstraction team was experiencing. These frustrations were unknown to the providers and causing a great deal of wasted time and energy for abstractors in our system. More importantly, we were concerned about the accuracy of our data if we did not have a solid connection with our quality team. The solution-based ACE review process provided us with focus and momentum to correct our situation. This continues to be an ongoing area of work for us, and we collaborate with ACE to update our progress and barriers. This sharing of experience is an additional resource we value from the ACE process.
(Unexpected) Benefit 5. ACE accreditation is cost effective.
ACE reviewers provided quality action plans and suggestions that helped us speed up our internal improvement processes. It would have taken us a year to do what ACE did in 90 days, assuming we could get unbiased feedback and actionable results. If we had to create an accreditation program ourselves, we would have spent as much or more as the cost of the ACE accreditation, considering employee hours.
ACE mitigates the risk for hospital stakeholders. We have to expect that PCI cases deemed inappropriate will be challenged by both payers and consumers. No one wants to be doing work labeled inappropriate; we use the ACE tools to validate and improve the care we provide. ACE delivers a proactive program that is an investment toward future contracts and market share.
ACE exists to help you on your quality journey and certifies that your cath lab is ahead of the curve in meeting appropriate care standards. Through focus, standardization, prioritization and feedback, ACE partners with the hospital to provide best practice models and opportunity. ACE expertise sets you up to move your program from “good” to “great!” in achieving quality patient care.
Anne Beekman can be contacted at: Anne.Beekman@spectrumhealth.org.
Learn more about ACE at http://www.cvexcel.org.