This page contains a Flash digital edition of a book.
ing Wisely campaign among Texas physi- cians. Read about the campaign at www .choosingwisely.org/.


The AMA/Joint Commission strate-


gies were the product of the 2012 Na- tional Summit on Overuse organized by the commission and the AMA-convened Physician Consortium for Performance Improvement. A joint paper outlining the recommendations describes over- use “as the provision of medical inter- ventions or treatments that provide zero or negligible benefit to patients, poten- tially exposing them to the risk of harm. While many medical procedures are as- sociated with tradeoffs between benefits and risks, the risks that are incurred in instances of overuse are not balanced by benefits to patients,” states the report, Proceedings From the National Summit on Overuse. It can be found at www.ama- assn.org/resources/doc/cqi/overuse- proceedings-paper.pdf. A group of advisory panels that in- cluded physicians targeted five areas for reduction and outlined steps to reach those goals, such as educating patients. They include:


• Antibiotic use for viral upper respira- tory infections: Develop clinical defi- nitions for viral and bacterial upper respiratory infections; align current national guidelines that are contra- dictory.


• Over-transfusion of red blood cells: Develop a tool kit of clinical educa- tion materials for doctors and a sepa- rate informed consent process for transfusion that communicates the risks and benefits.


• Tympanostomy tubes for middle ear effusion of brief duration: Develop performance measures for appropri- ate use of tympanostomy tubes, and determine the frequency with which tympanostomy tubes are inserted for inappropriate indications in other- wise healthy children.


• Early-term, nonmedically indicated elective delivery: Standardize how gestational age is calculated. Make the indications and exclusions list for early elective deliveries as compre- hensive as possible to improve clinical practice.


• Elective percutaneous coronary in- tervention: Encourage standardized reporting in the catheterization and interventional procedures report. Also encourage standardized analysis/in- terpretation of noninvasive testing for ischemia.


“The AMA is committed to improv- ing health outcomes; this important work will help health care profession- als ensure that the right patient gets the right treatment at the right time,” said AMA President Ardis D. Hoven, MD. “As part of our strategic focus on improving health outcomes, one of our goals is to contribute to the appropriate use of fi- nite health care resources, and this will help us achieve that goal.” Joint Commission President Mark R.


Chassin, MD, said, “Overuse is a serious problem that involves many complex decisions between doctors and patients. The recommendations from the summit will raise awareness that will help both doctors and patients make better deci- sions going forward and will ultimately improve quality and patient safety.” As a Choosing Wisely partner, Texas


Medical Association President Stephen L. Brotherton, MD, a Fort Worth orthopedic surgeon, says physicians are poised to take a leadership role in reducing waste and improving quality for their patients. Because every patient is unique, how-


ever, he stressed that the practices iden- tified by Choosing Wisely “are not meant to be absolutes, but guidelines that in- clude indications when a test or proce-


dure may be appropriate. The campaign is not about cookie-cutter medicine but about starting a conversation between a patient and his or her physician about the best method of care.” As a member of the initiative, TMA


will work with Texas physicians, state specialty societies, and county medical societies to educate doctors about the campaign’s recommendations, which can be found at www.choosingwisely .org/doctor-patient-lists/. Texas Medicine will have more details on the state effort as it develops.


Report: Quality factors into physician compensation


Quality performance showed up as a small yet emerging component of total compensation for physicians in the Med- ical Group Management Association’s (MGMA’s) annual physician compensa- tion survey, a trend the Texas Medical Association also has identified and cre- ated tools for to help physicians prepare as payers increasingly link payment to quality and cost measures. According to the survey, primary care physicians reported that 3 percent of their total compensation was based on quality metrics; for specialists, 2 per- cent. Patient satisfaction measures also


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September 2013 TEXAS MEDICINE 63


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