AHRQ Grants for Diagnostic Error

Xavier Prida dr.xavier.prida at GMAIL.COM
Tue Apr 14 18:31:53 UTC 2015


Insurance companies should not have even a subordinate role, in that they
possess the identical conscious or unconscious, intentional or
unintentional bias conflict of interest(COI) of a fiduciary responsibility
to the shareholders of the corporation(identical biases that physicians
have in a fee for service environment-but opposite incentive).

On Tue, Apr 14, 2015 at 11:30 AM, Jackson, Brian <brian.jackson at aruplab.com>
wrote:

>  There’s an important point in this thread that I want to call out.
> Health insurance companies are NOT the right entity to play the main role
> in ensuring high quality care.  They’ve only stepped into that role because
> clinical care delivery entities (medical groups, hospitals, etc.) haven’t
> fully owned it.  And I suspect this is largely because of a
> misunderstanding of the role of professionalism.
>
>
>
> Utilization reviewers working for insurers will never be in a good
> position to assess clinical quality because they’re organizationally too
> distant from the point of care.  What we need instead are more front-line
> leadership roles filled by experienced doctors who supervise their peers,
> reporting up to clinically-trained top-level leaders.  In an ideal world,
> insurance companies would play a subordinate role.  Or to paraphrase a VP
> at Intermountain Health Care (I forget his name), health insurers should
> own actuarial risk (who gets what diseases) and healthcare delivery systems
> should own medical risk (how much value is delivered to those patients).
>
>
>
> --Brian Jackson
>
>
>
>
>
> *From:* Phillip Benton [mailto:
> 0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
> *Sent:* Monday, April 13, 2015 3:23 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
> *Subject:* Re: [IMPROVEDX] AHRQ Grants for Diagnostic Error
>
>
>
> Rob & Mark,
>
>
>
> Yes, theoretically the insurance carrier should be the primary filter, but
> most of the reviewer's who pre-certify (approve/turn down) surgery
> requested have little or no formal medical education, and operate strictly
> from a computer screen that lists what they will or will not approve for a
> certain diagnosis. Whether it is unnecessary or excessive at that point in
> time (with so little symptomatic disease, confirmed by appropriate studies)
> is outside their discretion.
>
>
>
> 'Second Opinion' also falls short of controlling inappropriate or
> unnecessary surgery (see L. Leape, attached). In small communities, friends
> may approve each other's cases without the insurors' knowledge. Some
> specialty societies, such as North American Spine Society, are working
> actively to establish *'surgical appropriateness criteria'* to help apply
> the clinical practice guidelines its' dedicated guideline committees have
> worked so hard to formulate.
>
>
>
> Many have written about this (Leape, Epstein, others) but no one yet has
> tried to take real action. Deyo & Mirza in 2010 described a *15-fold
> increase in complex surgery for spinal stenosis *(as occured in my Power
> Point example) between 2002 and 2007.
>
>
>
> The JC's Mission Statement extols *'Quality Care and Patient Safety*' in
> hospitals it accredits, but it has not yet acknowledged or confronted the
> problem of  unnecessary or excessive surgery. When asked JC says they
> depend upon the hospitals QA committees to control this -- but there are no
> guidelines, no monitoring and no sanctions for cases such as that described
> in my Spinal Stenosis PowerPoint. I am preparing a presentation to The
> Joint Commission on this point and I may ask SIDM to weigh in.
>
>
> Phil Benton
>
> Atlanta, GA
>
>
>
>
>
> -----Original Message-----
> From: robert bell <rmsbell at ESEDONA.NET>
> To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Sent: Mon, Apr 13, 2015 2:32 pm
> Subject: Re: [IMPROVEDX] AHRQ Grants for Diagnostic Error
>
> Excellent point.
>
>
>
> Where are the loyalties of the Joint Commission - are the mainly patient
> or hospital?  Who pays the JCs fees? I ask this as there seem to be 100s
> many areas where the JC could help reduce errors to a far greater extent.
> Accurate data collection could be a start.
>
>
>
> Insurance carriers often are asking for approval for expensive procedures,
> operations, or drugs. Do they ever challenge a surgeons decision to perform
> an operation?  Are second opinions ever sought in those situations?  Could
> the Insurance Carriers be the filter that you ask for?
>
>
>
> But let’s not forget ambulatory care diagnostic errors, which must be
> massive, when so many do not have the training to diagnose many of the
> conditions.
>
>
>
> Rob Bell
>
>
>
>  On Apr 13, 2015, at 10:32 AM, pgbentonmd at aol.com wrote:
>
>
>
> Rob, Mark and SIDM,
>
>
>
> I would like to add another very important area in which "diagnostic"
> errors may cause massive and irreparable patient harm. I'm talking about
> not an error of diagnosis, but about the misapplication of surgical
> treatment indications for some diagnoses.. Currently there are no barriers
> to posting surgery that is inappropriate (viz unnecessary or excessive) for
> the underlying diagnosis.
>
>
>
>  Patients usually have given their "informed" consent to the procedure
> because they trusted their physician. Most physicians are trustworthy, but
> some surgeons looking to enhance the surgical fee treat surgically all
> pathology seen on the diagnostic imaging, or do the surgery
> prematurely. Attached, anonymized, is one example.
>
>
>
> What we really need is a diagnosis related "appropriateness criteria"
> screening system at the surgery scheduling desk that the OR nurses can
> understand and apply, that can trigger review of questionable case postings
> by senior surgeons with departmental administrative responsibility for
> quality of care. The Department Chair will also need timely backup
> consultation available from specialty society Practice Guidelines
> Committees when needed.
>
>
>
> Hopefully Joint Commission will face the problem and  join this effort to
> ensure patient safety and quality care in America's accredited hospitals.
>
>
>
> Phillip G. Benton, MD, JD
>
> Atlanta, Georgia
>
>
>
> -----Original Message-----
> From: robert bell < rmsbell at ESEDONA.NET>
> To: IMPROVEDX < IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Sent: Mon, Apr 13, 2015 11:33 am
> Subject: Re: [IMPROVEDX] AHRQ Grants for Diagnostic Error
>
> That was the point I was trying to make previously, and asking where most
> diagnostic errors are to be found.  In hospitals or in private specialty
> practice and primary care practice?
>
>
>
> If it is thought that most diagnostic errors come from the latter, then
> funding should be be available there.
>
>
>
> Rob Bell
>
>  On Apr 12, 2015, at 4:24 PM, Julianne Nemes Walsh < nemeswalsh at GMAIL.COM>
> wrote:
>
>
>
> After reviewing the grant criteria, primary care practice groups that are
> not attached to a higher ed institution are not eligible.   Would love to
> see grant opportunities available to smaller settings to stimulate more
> diversified opportunities for all levels of providers interested in
> diagnostic error.
>
>
>
> On Thu, Apr 9, 2015 at 9:52 PM, <graber.mark at gmail.com> wrote:
>
> This is a big day for our diagnostic safety community:  AHRQ has just
> issued the first-ever grant announcement that specifically targets “
> Diagnostic Safety in Ambulatory Care”.  Both R01 (large grants) and R18
> (small grants) will be funded under this initiative, which will be open
> annually until 2018.  With so many proposed, but untested interventions
> that have been raised, there’s many opportunities.  Go get ‘em !
>
>
>
> Mark
>
>
>
> Mark L Graber MD FACP
>
> President, SIDM
>
>
>
> *Title:     Understanding and Improving Diagnostic Safety in Ambulatory
> Care: Strategies and Interventions*
>
> Deadline Date:  Standard due dates apply: January 25, May 25, and
> September 25.
>
> For details, click on the link below:
>
> http://www.egrants.net/Public/index.cfm?ID=17660&UserID=graber%2Emark%40gmail%2Ecom
> <http://www.egrants.net/Public/index.cfm?ID=17660&UserID=graber.mark@gmail.com>
>
>
>
> or copy the above link into your web browser and hit the enter key.
>
>
>
>
>  ------------------------------
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>
>
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
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>
>
>
>
>  ------------------------------
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>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
>
>
>
> Robert M. Bell, M.D., Ph.C.
>
> P.O. Box 3668
>
> West Sedona, AZ  86340-3668
>
> USA
>
> Tel: Fax: 928 203-4517
>
>
>
> I am changing my e-mail address to  rmsbell200 at yahoo.com
>
>
>
> Kindly change the e-sedona e-mail above in your address book so  we stay
> in touch.
>
>
>
>
>
>
>
>
>
>
>
>
>  ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
> <Spinal_Stenosis.ppt_BASIC +.pptx>
>
>
>
> Robert M. Bell, M.D., Ph.C.
>
> P.O. Box 3668
>
> West Sedona, AZ  86340-3668
>
> USA
>
> Tel: Fax: 928 203-4517
>
>
>
> I am changing my e-mail address to  rmsbell200 at yahoo.com
>
>
>
> Kindly change the e-sedona e-mail above in your address book so  we stay
> in touch.
>
>
>
>
>
>
>
>
>
>
>  ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
>  ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
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>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>



-- 
Xavier E. Prida MD FACC FSCAI
Assistant Professor of Medicine
USF Morsani College of Medicine
Department of Cardiovascular Sciences
Tampa, Fl






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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