News from MSQC, June 2016
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A Note from Skip and Greta

Friends -

First, a mea culpa.  My lovely niece is having a destination wedding, in the British Virgin Islands, on - you guessed it - June 10.  So as much as I would like to be at the Kalamazoo Collaborative meeting, instead I will be at a very happy family event, on the beach, but probably swatting a few mosquitos also. Mike Englesbe and Greta Krapohl will be running the show, and I know they will do a great job as always. We have a full agenda, available to view here.

Greta and I want to bring you up to date on a few important topics.  

It is now a year since we contracted with ArborMetrix, and it is appropriate to reflect on the transition to the new data collection platform, particularly to focus on the difficult parts as you, the users, have related them to us. We want you to know that we take your concerns and suggestions very seriously, and have spent many hours in the past few weeks going over each comment we have received.  Arbor has a new, very experienced and capable CEO, Kurt Skifstad, who has put MSQC at the top of his priority list, for which we are grateful. Our joint priorities for the next six months are to improve the user experience in the workstation, expand data integration, and make the sampling workflow more efficient.  Matt Callow and Kelsey Fegan from our end have done a superb job, and devote all of their efforts to these areas.  It’s a good partnership. Please keep your comments coming.

Secondly, as we ramp up our efforts around data integration, there has been some discussion about the purpose of including *all* of the eligible CPT code cases in the data submission to Arbor, not just the sampled cases as we had previously done.

I would like to assure you that this information is just as protected as our sampled cases, but it is pure administrative data, unverified by a nurse. It serves as a useful case denominator, among other things, but the main point is that we think it is important to learn what insights we can get out of this stripped-down data, as we move to a more automated electronic system. Hopefully we will end up with a hybrid approach in which the number of traditionally sampled cases is reduced, and the information imported electronically is increased. This approach will allow SCQRs more time to work on Quality Improvement Initiatives and interact clinically with other providers, which is our goal. But we can’t get there without trying something new. More information on our hybrid approach to data integration is available here.

The newsletter would not be complete without a quality update of some kind. We are doing extremely well on most fronts, and importantly on implementation.  Many of you attended the excellent workshop put on by Bob Cleary and his St. Joe’s colleagues regarding ERP, and the majority of our hospitals now have some version of ERP or specifically prehab ongoing as part of their Performance Index project.  

Also, we are making steady progress on our oral antibiotic as part of the mechanical bowel prep protocol, as you can see below, with an associated reduction of SSI in the colectomy population.  Incidentally some of our surgeons believe that oral antibiotics are not necessary for right colectomies, only left colectomies, but I heard a presentation at the recent American Society of Colon and Rectal Surgeons meeting last month that showed a distinct benefit for right colectomies also.  Sam Hendren and Andy Mullard are now looking at our MSQC data to look at the same issue.  More later on that.


If you haven’t yet had a chance to look at the excellent SSI toolkit on our website, under “Quality Improvement Resources” please do.  Many of our team worked on this effort, but particularly JoAnne Todd, and it is just excellent.  Comprehensive, up to date, and helpful. 

Finally, we continue to prepare our surgical teams for the coming payment reform.  This is going to affect every one of us eventually, and could profoundly influence the practice of surgery. We need to use the goodwill of our members, and our massive data capabilities to put forth our opinions and to influence policy.  The field is fluid right now, important decisions are being made by government and other payers, and we want to be in the middle of these discussions.  For example, some of us are now preparing a manuscript based on MSQC experience which describes what the elements of a “high value” colectomy bundle should be, and what a reasonable 90 day episode payment for such a “bundle” might be also.  I don’t know of any other organization that can put together this type of real world information.

As always, I want to thank each of you for your support and continued commitment to improve surgical care in our state. Enjoy Kalamazoo!

Skip & Greta

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