Quality & Practice Background Information

Background

The cost of healthcare in the United States continues to rise. For several years, the government as well as other interested parties, such as third party payers, has tried to disrupt this pattern. Past interventions, focused on curbing costs by indiscriminately cutting expenses, are no longer an effective management practice.

To decrease the cost of healthcare a different approach is being utilized. Physicians will no longer be rewarded solely for the volume of services rendered. The new strategy will tie reimbursement to the quality of care physicians deliver with respect to parameters set forth by various payers. This will result in a more efficient system.

Clinical evidence and data are the foundation of this new system. Moreover they function as the material necessary to address topics such as overuse, underuse, defective, and cost prohibitive care in the context of quality improvement. This indicates that evidence will be used to redefine best practices in medicine and produce capturable performance information. The transparency created by the process will have a direct impact on the practice of medicine since physicians will now be accountable for the results their decisions produce.

Engineers have long known that they can’t manage what they don’t measure. Public and private payers have erected an infrastructure, as well as supporting programs, around this principle. The Physician Quality Reporting System (PQRS), which captures performance measures, is an example of the latter. Regrettably, the programs are moving in a direction that makes it difficult for nuclear medicine physicians to participate. Specifically, the programs are implementing criteria that are geared towards physicians with direct patient contact (i.e. primary care and surgeons). For example, nuclear medicine physicians provide oncologists with information that will help them manage patient care. When this interaction is reported, oncologists are able to report an outcomes measure. The nuclear medicine physician reports a process measure. This is important because programs are moving away from process measures to outcomes measures.

What We Are Doing

Due to the dynamic nature of healthcare, the Society of Nuclear Medicine & Molecular Imaging (SNMMI) proactively changes strategic goals. These are intended to add value to the stakeholders of the nuclear medicine & molecular imaging community. For over a decade, SNMMI has developed guidelines to harmonize the practice of nuclear medicine. It has also developed quality measures and appropriate use criteria.  With the advent of a new quality department, the Society is preparing to create evidence-based guidance documents to support the nuclear medicine community in the evolving healthcare landscape. Additionally, SNMMI provides its members a voice by actively working with many stakeholders of the quality community.

Quality Improvement Stakeholders

It would be ideal to have one entity take ownership of all quality improvement activities. The complexities of the healthcare system does not allow for such a situation. Fortunately, a framework exists that allows for efficient communication among the various stakeholders. To learn more about some of the major players in the quality improvement space, please browse the links below:

• Centers for Medicare & Medicaid Services (CMS)
• Patient-Centered Outcome Research Institute (PCORI)
• Physician Consortium for Performance Improvement (PCPI)
• Agency for Healthcare Research and Quality (AHRQ)
• National Guidelines Clearinghouse (NGC)
• National Quality Forum (NQF)
• Council of Medical Specialty Societies (CMSS)