Questions? Want to be a panel member? Have suggested topics ? Contact: Skip Valusek

1. Welcome to the MHQP & HealthForce MN Quality Brownbag RoomMonthly Noon Brownbag Fourth Thursday Every Month Peer Review in the Clinics Panel: HCMC HealthPartners March 3rd 4th Annual CPHQ Exam Prep Nancy Claflin @ VA Med Center Questions? Want to be a panel member? Have suggested topics ? Contact: Skip Valusek MHQP Education Chair skipvalusek@comcast.net Slides are posted at: http://www.healthforceminnesota.org/pages/Programs/courses.html

2. Register your Attendance Hopefully you provided your name & organization when you signed in. • If so: Just say Hi in the Chat Pod and we’ll capture your name and organization in the log. • If not: identify yourself and organization in the Chat Pod to the left of your screen.

3. Rural / Outstate ? Metropolitan area ? Organization that has (or serves) both ? Poll: Who is Attending this Session ? 3 5

4. Healthcare system Hospital Clinic or Clinic System Long term care Healthplan Homecare / Hospice A Quality Support Organization Other ? (e.g. MCM ) Poll: Who is attending: Organization Type ? 5 1 1

5. 1 2 3 4 5 6 7 >7 Poll: How many total participating in your room ? 4 3

6. I am a healthcare quality professional and am interested in additional education. I am a healthcare professional interested in developing quality skills as a core competency. I am a healthcare professional interested in learning more about healthcare quality. Poll: What do you hope to gain by participating? 6 1

7. Panel Members • HCMC • Dr John Hitt : Chief Quality Officer • Kathleen Ganter: Medical Staff Quality and Safety Coordinator • Leah Harren : Peer Review Coordinator and Healthcare Data Analyst • HealthPartners Medical Group and Clinics (HPMG) • Anita Hayek RN, BSN : Sr. Quality Peer Review Coordinator • In this role > 10 years

8. Poll: If your institution has both ambulatory and acute care (e.g. hospital) , what is the volume of cases in ambulatory versus acute care peer review? Ambulatory has: • Definitely less • About the same • Definitely more 3 2

9. Poll: What is the severity of peer review cases in ambulatory versus acute care? Ambulatory is: • Definitely not as harmful to patient and/or staff. • About the same degree of harm to patient and/or staff. • Definitely more harmful to patient and/or staff. 4

10. Poll: How different is your institution’s ambulatory peer review process from acute care peer review? Ambulatory is: • Very different • About the same • The same process, with the same committee members • Other 1 4

11. What is your process for PR in ambulatory care? How is it different than the acute care peer review process? • HCMC • The peer review process is the same in both settings • There is a separate ambulatory care quality committee because of • concern that ambulatory might get lost in a joint committee with acute care • Same sources trigger case screening and review. • HealthPartners • The HPMG process is different than Regions which uses triggers (e.g. • readmissions, deaths) to identify potential cases • HPMG uses complaints, picker data, web page feedback and other sources • to identify potential cases

12. Explain the roles and responsibilities of your Peer Review team/committee. • HCMC • There is one, 16-member multi-disciplinary Medical Staff Quality Committee • Peer review is one of the responsibilities of the committee • A workgroup staffs the process of screening; review, comment and prep for • discussion; preparation and delivery of findings • Results are in two major categories: • Professional skills and knowledge • Comportment • The Chair of the committee sends follow-ups and letters. • Any containing findings other than normal activity is hand-delivered which • diffuses “blame” and emphasizes improvement. • Many Performance Improvement Projects (PIPs) have resulted • Results are contained in provider’s OPPE • HPMG • Has 9 committees with approximately 10 members each, have an • Interdepartmental committee • The cases are prepped, reviewed, results consolidated and blinded • The committee members become mentors for reporting cases • Results are either systems issues, clinical “pearls”, or focused reviews

13. How do you determine what to review for ambulatory Peer Review? We skipped this question because it was answered in the previous questions: each system has trusted sources, either using automated triggers or manual review to create the queue of potential cases. Complaints, safety, outcomes data, coded complications, and satisfaction surveys are all used.

14. What are The Joint Commission and other healthcare accreditation organizations’ requirements for Peer Review in the ambulatory care setting? We skipped this question to allow time for other questions.

15. What are your action/decision categories? • HCMC • Has 6 buckets: • Outcomes • Affect on patient care • Provider documentation • Type of case [e.g. diagnosis; knowledge] • Overall care [appropriate; inappropriate; controversial; exemplary] • Resulting actions • The time between visits is generally so great that documentation becomes • a critical success factor for both care and peer review • The current process is raising expectations regarding care and documentation: • Documentation is an important part of care. • HealthPartners • Rules are used to trigger focused reviews: 3 variances or one major variance • 4 buckets: • Final outcome [ 0=appropriate; 1=variance;2=mgt controversial; 3=major variance; negligent] • Subcode[coordination of care; communication; technical competence] • Outcome [no adverse affect; minor adverse affect; major adverse] • Documentation [ adequate; inadequate]

16. How do you document and share Peer Review activities and results? • HCMC • Hand deliver letters with cc to Dept Chair • Summary of results to Med Exec committee • Advertising PIPs that result from the review • Provider groups share the learnings • Committee has made great strides transitioning from blame-n-shame • “Got-ya” to an improvement focus • There is much more multi-disciplinary improvement occurring • HealthPartners • Letters are electronic with cc to Department Heads • Each clinic reviews complaint data • the Access database is used to identify patterns • Summaries: • quarterly systems issues • 6 month coordination meeting with Regions hospital • Annual summary of counts, focuses on themes • Each individual in the clinic is trained and responsible for service recovery.

17. How do you know that the process works? • HCMC • As with any cultural quality change . . . “we’re not sure yet” • We have hints that it’s working: • There are industry benchmarks that suggest the number of cases • we should be seeing. We’re not getting that number. • We compare case reviews with other sources • A problem occurs and multiple sources let us know is happened • PIPs are attributed to the process • Attorney calls tell us when it’s not working • HealthPartners • We are surfacing things to be fixed • We are sharing learnings • We have increased staff participation in reporting concerns

18. Reference: AMA article on Medical Peer Review: http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/medical-peer-review.page

19. Questions ?Type them in the Chat Pod

20. Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month January 26th Topic TBD March 3rd 4th Annual CPHQ Exam Prep Nancy Claflin @ VA Med Center Questions? Want to be a panel member? Have suggested topics ? Contact: Skip Valusek MHQP Education Chair skipvalusek@comcast.net Slides are posted at: http://www.healthforceminnesota.org/pages/Programs/courses.html