Editor’s Notes

Jeff Pothof MD, FACEP
Newsletter Editor

Jeff PothofA handful of events and announcements have been made since the last edition of this newsletter.  First off, we’d like to announce the QIPS Section's partnership with the Emergency Medicine Patient Safety Foundation (EMPSF).  EMPSF is a non-profit organization that has been promoting the practice of quality healthcare as it relates to Emergency Medicine since 2003.  EMPSF has created a special page for QIPS members featuring complimentary access to its educational webinar series, CMS & EMTALA updates and speaker presentations from its Patient Safety Summits. Please click here to access EMPSF patient safety resources.

On April 1st, 2014 QIPS hosted an All-Section call on 2014 Updates to the CMS Physician Quality Reporting System (PQRS) and the Physician Value-Based Payment Modifier (VBM).  This session was led by Dennis Beck MD, FACEP, Mike Granovsky MD, FACEP, and Rick Newell MD, FACEP.  This information will be very useful to EM providers in general, and something I encourage all of you to look at if you were not able to make the call.  Although not nearly as exciting as “The Hunger Games,” this read could make you money or at least help you from losing it.  The presentation is available here.

A few summary points from the call included:

  1. In the past, reporting of PQRS measures was optional.  EM has the highest reporting rate of any specialty at 67.2% of emergency physicians reporting.  Starting in the 2015, failure to participate in reporting PQRS measures from 2014 data will result in a 1.5% negative payment adjustment.
  2. To ensure you will earn your 2% you should
        a. Report on the following PQRS Measures;
                # 28 ASA/MI
                # 54 EKG/chest pain
                # 55 EKG/syncope
                # 56 Pneumonia/Vital Signs
                # 59 Pneumonia/Antibiotics
        b. Verify you saw less than 15 pregnant Medicare patients per provider;
            i. If you did see 15+ pregnant Medicare patients report on measures 254 and # 255 (RH Immunoglobulin for RH- / Risk of Fetal Blood Exposure
        c. Do not report additional measures that may reside in another cluster.
  3. The VBM had its genesis in the Accountable Care Act and will be fully implemented by 2017.
  4. For 2016, you can avoid the VBM 2% negative adjustment by having >50% of emergency physicians in the same Tax ID number.
        a. Successfully earn 2014 PQRS incentive or
        b. Avoid the 2016 PQRS negative adjustment
  5. If you report as a group you can avoid the VBM 2% adjustment if the group Tax ID number reports PQRS on >50% of the Tax ID numbers eligible on Medicare Fee for Service Patients
  6. In the future PQRS will represent the quality of the care delivered and VBM will represent the cost efficiency of the care.  Emergency physicians will then receive a bonus for high quality low cost care and a penalty for high cost low quality care.

We also have some great articles in this newsletter.  Dr. Beach highlights some of the kudos received in the press recently about the increase in safe patient care and error reduction in the US healthcare system.

Dr. Jaben discusses the perils of the plug and play quality or process improvement project as the devil is usually in the details despite our best intentions.

Dr. Phrampus makes a case for why a Just Culture is the way to go when it comes to quality improvement and peer review. Does your system still punish the individual when a mistake happens?  There may be more to the story than just the sole provider.  Read about how those practicing best-practice-peer-reviews have adopted “A Just Culture.”

Dr. Meyers concludes his summary of issues that came out of the “Future of Emergency Medicine” conference with topics such as EMTALA, frequent flyers, and cost reduction strategies.

Did that last overnight shift almost kill you?  Don’t laugh: it may very well kill you eventually. That overnight shift may also account for those pounds around the waist line you wish weren’t there or that diastolic blood pressure reading you’ve written off as being white coat hypertension.  Shari Welch MD, FACEP looks at some of the recent studies published about night shift workers.  If you want to know how to live longer, stay tuned to her follow up QIPS TIPS in the next newsletter.


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