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CASTS leads legislative update of public reporting law

Message from Junaid Khan, CASTS President:

(Updated September 27, 2016)

Last year CASTS heard a number of complaints regarding denial of payment for second assistants. We met with the Medicare vendor and helped clarify the rules related to title 22.  It is clear that roughly 2/3 of you do not bill for second assistants (Universities, Kaiser, places were PA employed by the hospital). The remaining 1/3 have had much more success in correctly dictating their operative notes and collecting for their second assistants after our meetings with Noridian (the Medicare vendor). If you still have questions please let us know.

The vast majority of you have expressed a strong opinion that PCI outcomes should be publicly reported. CASTS has been working with OSPHD and California Assembly leadership, where Title 22 resides and there is some hope of making this come to fruition in the next year. A modest cost of $50,000 is needed to help navigate this through the state assembly.  In March we queried all CA surgeons who are subject to public reporting, asking them or their organization or hospital, to consider a pledge of $1000 to specifically direct towards this effort. Not unexpectedly, this appeal met with a lukewarm response. 

Proposed Legislative Update:

The March 9, 2016 appeal letter pointed out that historically, reporting of CABG procedures was implemented through SB 680, a law proposed by the Consumers Union, in 2003. The law was supported by the California Chapter of the ACC (CAACC) after successful lobbying to establish a Clinical Advisory Panel consisting largely of cardiac surgeons and cardiologists. The panel recommended reporting of PCI procedures in 2014, but the required legislative amendment failed in financial committee review.

In September 2014, however, SB 906 was passed to allow implementation of “stand alone” PCI facilities, or PCI programs at sites without surgical backup. This was successfully accomplished, establishing the framework for a new attempt at legislative approval to report all PCI procedures.

Dr. Bill Bommer, cardiologist at UC Davis and President of the CAACC, was the author of SB 906. He has suggested that CASTS provide funding for a legislative update, reasoning that while CAACC funded the original law to report on surgeons, the membership was not likely to support a law to report on themselves. 

Dr. Bommer’s plan for a new legislative update is as follows:

Public Reporting California Proposal

  1. Review public reporting states protocols: NY, PA, NJ, MA
  2. Address issues of High Risk Patients
  3. Hire Lobby firm to set up:
    a. Initial meetings with authors
    b. Meetings with stakeholders
    c. Meetings with committee chairs
  4. Write language for Public Reporting Bill
  5. Follow up Submission of Bill
  6. Schedule meetings with committee chairs
  7. Schedule meetings with committee members
  8. Attend committee hearings (10)
  9. Follow up on amendments
  10. Meet with Appropriations Chair.
  11. Schedule meeting with Governor's staff
  12. Meet with Public Reporting Agency

The Budget would include: $3-4000/month (12 months) for the services of a Lobby Firm, $1000 for parking and travel expenses. Total cost $37,000- 49,000.

A meeting is was held on March 18 at UC Davis with representatives of CASTS, CAACC and OSHPD to develop the plan for preparation and funding of the new legislative amendment. At this meeting, Dr. Bommer suggested that OSHPD administrative data might be useful to identify possibilities for performance improvement.  Clearly, funding for a legislative update would not be forthcoming any time soon.  Therefore it was suggested that a clinical advisory panel be formed to study OSHPD PCI data.  Subsequently, 2015 data has been obtained and the CCSIP project has been submitted for continuing review.  For the moment the legislative update has been tabled. 

Quality Improvement Goals of the CASTS

The CASTS would like to engage patients and other healthcare stakeholders, as well as physicians and cardiac team members, in the quality improvement process. Consistency and transparency in information sharing is critical to the process of communication across personal and professional boundaries. Input from all disciplines and individuals must be sought and valued.

The "heart team" concept has provided a platform to bring together cardiovascular specialists from various disciplines in the patient care process.  New procedures such as transcatheter aortic valve replacement have required the integration of surgeons and interventialists to make decisions concerning indications and approaches.  Guidelines for coronary interventions require concordant decision-making by cardiologists, surgeons and caregivers for patients with advanced disease. Establishing a dialogue, an action plan, and a QI agenda involving multiple heart programs, practices and heart team members will favorably impact standards of care.  Defining a model quality agenda for the state's cardiac surgical community is a CASTS priority.

The CASTS therefore would like to encourage all heart team members to participate in society activities, including physician assistants, perfusionists, nurses, operating room staff, data managers and administrative personnel.  Accomplishing this laudable goal has not been easy or obvious.  Following the death of our Executive Director, Ed Fonner, in 2014, data managers and quality administrators at heart hospitals formed a separate organization. The CASTS leadership has believed that this is counterproductive to the heart team concept. Our objectives remain the same:

  1. Collect, share, and analyze patient data concerning safety, quality of care, and process innovations in the cardiac surgery area to improve decision-making on quality and cost management issues;
  2. Create a collaborative infrastructure which can monitor and analyze outcomes, develop best practice care processes, and through process improvement enhance the quality of care in cardiothoracic surgery;
  3. Facilitate communication and educational activities in the cardiac surgical community to ensure the integrity of publicly-reported healthcare information.
  4. Support education initiatives aimed at improving patient safety, health literacy, informed patient choice, and medical decision-making.

The creation of the CASTS was influenced by the need to monitor pubic reporting initiatives and ensure the quality of outcomes data. The interests of surgeons and heart team members go well beyond these areas.  However, these performance improvement goals remain central to the CASTS ideal of fostering collegiality among healthcare professionals and stakeholders in cardiac and thoracic surgery.

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