Cover: The next step in patient safety

Thursday, March 01, 2012 12:00 PM
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CMS, partners working to improve peer review

Susan Koontz, JD, General Counsel and
Senior Director of Government Relations
Chris Lines, Director, Political Education and Advocacy

Colorado Medical Society is leading an effort to improve the state’s professional review system – the latest step toward ensuring Colorado is the best place in the nation in which to provide and receive safe, high-quality and cost-effective medical care.

CMS and an array of partners worked together with legislators on a professional review (also known as peer review) bill that is currently moving through the General Assembly. House Bill 12-1300 enjoyed bipartisan support in the House of Representatives, where it passed in March. At press time, it is still being considered in the state Senate.

Among other things, the bill would maintain the confidentiality, privileges and immunities associated with professional review activities for seven years. It would authorize professional review of physician assistants and advanced practice nurses for the first time, and would specify sharing of professional review information with entities such as the Colorado Department of Public Health and Environment, the Centers for Medicare and Medicaid Services, and the Joint Commission, in addition to the Colorado Medical Board and the Colorado Nursing Board. The law would prohibit further disclosure of the records provided to these agencies and organizations.

The legislation is sponsored by physician and CMS member Sen. Irene Aguilar, MD, D-Denver and Rep. Bob Gardner, R-Colorado Springs. (See the Final Word for more from the two bill sponsors).

Aguilar said she hopes the legislation will help more physicians and other professionals feel comfortable referring cases to peer review, and that those cases will lead to safer care and improved systems. She also hopes more professionals will serve on peer review committees if the bill becomes law.

“Whenever you conduct peer review it helps you improve your own practice, because you look at a case and think ‘I could have done that, I might have done that.’ I think it makes you a better practitioner,” said Aguilar, who served on the state’s Board of Medical Examiners (now known as the Colorado Medical Board) from 1993 to 2001, and has done case review since then. “We can be our own best advocates,” she added.

Gardner told his colleagues during a hearing before the House Judiciary Committee that the bill has more moving parts than any he has worked on in his six years at the legislature, and praised the collaboration among its supporters. Among them are Rocky Mountain Health Plans, University of Colorado School of Medicine, Rocky Vista University, COPIC, the Colorado Psychiatric and Ob/Gyn societies, Colorado Academy of Family Physicians, Colorado Nurses Association, Colorado Hospital Association and Colorado Society of Advanced Practice Nurses.

“There is an important public policy reason for professional review, and you have to get it right,” Gardner said. “The interplay between the professions has been productive, not adversarial, and it has brought the very essence of how we are going to deliver care to the forefront.”

Years-long commitment
Improving patient safety has long been a CMS priority. In 2005, the CMS Board of
Directors gathered to draft the organization’s first strategic plan in more than a decade. The board didn’t miss the opportunity to include advancing patient safety and quality of care among its five banner goals.

Since then CMS has been working methodically on projects and programs to advance the goal, from encouraging better care coordination and continuing medical education to forming the CMS Workgroup on Patient Safety and Professional Accountability and making patient safety the focus of our 2009 Spring Conference, as well as a component in each of CMS’ major conferences. Legislatively, CMS has advocated for changes in the Medical Practice Act, including maintenance of licensure, to help improve patient safety.

Though Colorado’s professional review system was not yet scheduled for sunset review by the state legislature, CMS and its partners recognized that it was time to move forward with changes to this critical issue, and asked the Department of Regulatory Agencies and lawmakers to work with us.

“House Bill 1300 will enhance patient safety by upgrading and modernizing the body of law governing professional review,” said CMS President Brent Keeler, MD, who has more than 25 years of experience in professional review, having served as department chairman, chair of credentials and as a chief of staff at The Medical Center of Aurora.

“It benefits patients by creating a mechanism for prompt evaluation by informed evaluators, and uses the findings of that assessment to improve systems of care and professional practice,” Keeler said.

More than just physicians are committed to raising the bar on patient safety and quality improvement through this process.

“The APN community welcomes the opportunity to engage with their health care colleagues in robust professional review processes to promote high quality health care,” said Linda Siderius, legal counsel for CNA. “We were proud to be part of the coalition that worked together with CMS in the legislative process to achieve the necessary changes to the Colorado Professional Review Act to include the advanced practice nursing community.”

Maintaining confidentiality was a critical piece of the legislation for CMS and other supporters, because it is the lynchpin for good reviews and ensuring physicians and others will participate in the process.

However, if professional review results in an adverse action against a physician – such as suspension or revocation or limitation of privileges – this modernized law does allow for the sharing of professional review records and information with other hospitals and clinics where the physician practices for the purpose of improving care.

The bill requires professional review entities to register and report their activities – in the aggregate and without identifiable information – to the Division of Registrations. This reporting includes the number of investigations completed during the year as well as the results of these investigations, including the number of investigations that resulted in no action, the number of investigations that resulted in written involuntary requirements for improvement sent to the physician, APN or PA, and the number of investigations that resulted in written agreements for improvement between the physician, APN or PA and the entity.

The bill requires professional review entities to report on an annual basis to the Medical and Nursing Boards the number of final professional review actions relating to physicians, APNs and PAs in each of these categories: adversely affecting the individual, in which an entity accepted the individual’s surrender of clinical privileges; membership or affiliation in return for not conducting an investigation, in which an entity accepted the individual’s surrender of clinical privileges; membership or affiliation in return for not conducting an investigation, and in which the professional review committee made recommendations following a formal hearing. The boards will forward the reports to the Division in a de-identified manner.

The information will then be consolidated by DORA for the state of Colorado and reported to the public (also in aggregate and without identifiable information). This data may be particularly valuable because it will show trends, set benchmarks and show outlier data so systems may be improved.

“This legislation is well researched, the product of a highly collaborative process and most importantly, represents choices that are good for patients and patient safety,” Keeler said.

To follow the bill, visit or keep an eye out for e-mail updates via ASAP, our electronic newsletter.

Posted in: Colorado Medicine | Cover Story | Legislative Updates | Initiatives | Advocacy | Patient Safety and Professional Accountability


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