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Standards and Quality Committee Activities

1)  Representation of ASTS at the ACS Surgical Quality Alliance (SQA)and AMA Physician Consortium for Performance Improvement (PCPI) and attendance at SQA meetings in Washington, DC and bi-annual PCPI meetings in Washington, DC and Chicago. Areas of common interest include quality initiatives under healthcare reform, the National Quality Strategy, value based purchasing, P4P, PQRS, measure development, clinical registries, risk adjustment, attribution of results, public reporting and patient satisfaction surveys. 

2)  Prepared PQRS Primer (Feb 2012) on incentive payments available through CMS’s Physician Quality Reporting System. The primer offers information on how transplant surgeons can join, the peri-operative measures specific to transplant surgeons, and the worksheets and necessary coding information for billing. Also provided for members is the PQRS Internal Billing Form Example (Feb 2012). This is a priority because many surgeons do not currently participate and it is expected that PQRS reporting will become obligatory as CMS moves to value-based purchasing and performance based payments.

3)  Hosted a successful lunch and learn session on CMS requirements for a transplant center QAPI (quality assessment / performance improvement) program at the ASTS 12th Annual State of the Art Winter Symposium, January 12-15, 2012, Loews Miami Beach Hotel, Miami, Florida.

4)  Preparing ASTS guide with supporting materials on how to fulfill CMS requirements for a transplant center QAPI program.

5)  Developing transplant-specific performance measures, a priority as CMS moves to value-based purchasing and performance-based payments and the ABMS will increasingly require physician involvement in quality initiatives. Of concern, there are presently no transplant-specific PQRS measures. CMS standards for performance measures are robust. Measures need to be evidence based, address a gap in care and involve opportunities for improved safety, coordination of care, engagement of patients and families, and/or leveraging EHRs and registries. Measure development involves reviewing practice guidelines; drafting numerator and denominator statements, inclusions and exclusions and technical specifications by data source and CPT codes; public comment and CMS approval. ASTS is exploring measure development with PCPI, to decrease components of metabolic syndrome and renal dysfunction post-transplant (hypertension, diabetes, dyslipidemias, renal dysfunction), and with NSQIP, to decrease peri-operative morbidity. 

6)  Peri-operative measures currency project: Guiding SQA’s and PCPI’s proposed revisions to CMS’ peri-operative antibiotic and DVT prophylaxis measures for abdominal organ transplant and hepatic surgery procedures, including additions and removals to the procedure list for each measure and changes to the antibiotic regimen for certain procedures. 

7)  Consensus Conference on Optimal Testing of the Live Donor to Prevent Transmission of Infectious Diseases, 2011 – participated in implementation of recommendations workgroup.

8)  Facilitating deceased donor research (Scientific Studies Committee Project): collaborating with Scientific Studies and Ethics Committees and external organizations to propose draft guidelines that address barriers to donor research, complexities regarding consent (i.e. donors, recipients, providers) and possibly a national IRB-like endeavor.

9)  Working with the Liver Transplant Anesthesia Consortium (LTrAC)  to analyze surveys of anesthesiologists and co-author a manuscript on the findings.  

10)  Sponsored 2011 ASTS Winter Symposium Pre-Symposium: Pay for Performance - An Update on National Quality Improvement Initiatives. Focused on healthcare reform, value based purchasing, measure development/implementation, and the future of P4P. Speakers included B. Straube, MD (Chief Medical Officer, CMS), B. Rosof, MD (Chair, PCPI/AMA), F. Opelka, MD (Chair, SQA/ACS) and D. Stumpf, MD (United Healthcare). 

13)  Published ASTS Recommended Practice Guidelines for Controlled Donation after Cardiac Death Organ Procurement and Transplantation. AJT, Volume 9, Issue 9, Pages 2004 – 2011.

14. Submitted Standards for Organ Procurement to the OPTN/UNOS (2009).

15. Submitted recommendations for Definition of a Transplant Surgeon to the OPTN/UNOS (2009).