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When is too young for antiaging procedures?
DANA POINT, CALIF. – When is someone too young for antiaging procedures with cosmetic fillers or laser resurfacing?
Chronologic age "is somewhat irrelevant," in the opinion of Dr. Elizabeth L. Tanzi, codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery. "I’m looking at dermatologic age, with a critical evaluation of [a patient’s] need," she said at a meeting sponsored by SkinCare Physicians and Northwestern University.
Dr. Tanzi noted that genetics also plays a role in how each person’s skin ages over time. "Some people have inherited facial expressions," she explained. "They may get hyperdynamic movement in certain parts of their face and develop wrinkles much earlier than you would anticipate. Environmental exposure clearly plays a large role. Excessive ultraviolet exposure, growing up with outdoor sporting activities, tanning bed use, or poor habits such as smoking are going to lead to an accelerated aging process," she said.
The importance of establishing realistic patient expectations starts with the first office consultation, when clinicians emphasize that "we can slow down the signs of aging on your skin, but we cannot stop the process completely," said Dr. Tanzi, who is also an assistant professor of dermatology at George Washington University Medical Center, Washington. "I think it’s more important to talk about looking youthful, energetic, and vibrant, not necessarily looking young, because we may be inadvertently delivering the wrong message – that all aging is preventable if treatments are started early enough – and that sets the stage for unrealistic expectations."
Encouraging sun protection behaviors is sensible, and "most dermatologists realize that you can use neuromodulators and fillers strategically early on," Dr. Tanzi said. "But the idea of using fractionated laser resurfacing treatments to promote improved skin function is intriguing to me. We know we can improve the skin cosmetically through a series of fractional laser resurfacing treatments. But can we functionally improve the skin as it’s aging?" she questioned.
Cutting-edge research suggests that may be the case. In 2012, Dan F. Spandau, Ph.D., and his colleagues (J. Invest. Dermatol. 2012;132:1591-6) published data showing that dermal wounding procedures such as fractional resurfacing can "wake up senescent dermal fibroblasts to produce more insulin-like growth factor-1 (IGF-1), which helps the epidermis ward off the damaging effects of UVB on the skin," Dr. Tanzi said. In that case, she continued, "should we be recommending fractional resurfacing as part of a healthy antiaging routine? If so, at what age? These are exciting developments that need additional research to help guide new treatment protocols."
Although she is enthusiastic about preventing some signs of aging and helping patients maintain a youthful appearance, Dr. Tanzi expressed some concerns. "If we are not careful, we could be setting ourselves up for an expectation of being able to stop the aging process, and this can be a slippery slope, especially for women," she said. "Especially when it comes to fillers and neuromodulators, if not done judiciously they can lead to a very artificial look which, ironically, makes women look much older," Dr. Tanzi said. "As thoughtful physicians, it’s important to keep perspective and guide patients to know when enough is enough [in terms of procedures]," she added.
Dr. Tanzi disclosed that she is a consultant for Cynosure/Palomar, Lumenis, and other companies.
DANA POINT, CALIF. – When is someone too young for antiaging procedures with cosmetic fillers or laser resurfacing?
Chronologic age "is somewhat irrelevant," in the opinion of Dr. Elizabeth L. Tanzi, codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery. "I’m looking at dermatologic age, with a critical evaluation of [a patient’s] need," she said at a meeting sponsored by SkinCare Physicians and Northwestern University.
Dr. Tanzi noted that genetics also plays a role in how each person’s skin ages over time. "Some people have inherited facial expressions," she explained. "They may get hyperdynamic movement in certain parts of their face and develop wrinkles much earlier than you would anticipate. Environmental exposure clearly plays a large role. Excessive ultraviolet exposure, growing up with outdoor sporting activities, tanning bed use, or poor habits such as smoking are going to lead to an accelerated aging process," she said.
The importance of establishing realistic patient expectations starts with the first office consultation, when clinicians emphasize that "we can slow down the signs of aging on your skin, but we cannot stop the process completely," said Dr. Tanzi, who is also an assistant professor of dermatology at George Washington University Medical Center, Washington. "I think it’s more important to talk about looking youthful, energetic, and vibrant, not necessarily looking young, because we may be inadvertently delivering the wrong message – that all aging is preventable if treatments are started early enough – and that sets the stage for unrealistic expectations."
Encouraging sun protection behaviors is sensible, and "most dermatologists realize that you can use neuromodulators and fillers strategically early on," Dr. Tanzi said. "But the idea of using fractionated laser resurfacing treatments to promote improved skin function is intriguing to me. We know we can improve the skin cosmetically through a series of fractional laser resurfacing treatments. But can we functionally improve the skin as it’s aging?" she questioned.
Cutting-edge research suggests that may be the case. In 2012, Dan F. Spandau, Ph.D., and his colleagues (J. Invest. Dermatol. 2012;132:1591-6) published data showing that dermal wounding procedures such as fractional resurfacing can "wake up senescent dermal fibroblasts to produce more insulin-like growth factor-1 (IGF-1), which helps the epidermis ward off the damaging effects of UVB on the skin," Dr. Tanzi said. In that case, she continued, "should we be recommending fractional resurfacing as part of a healthy antiaging routine? If so, at what age? These are exciting developments that need additional research to help guide new treatment protocols."
Although she is enthusiastic about preventing some signs of aging and helping patients maintain a youthful appearance, Dr. Tanzi expressed some concerns. "If we are not careful, we could be setting ourselves up for an expectation of being able to stop the aging process, and this can be a slippery slope, especially for women," she said. "Especially when it comes to fillers and neuromodulators, if not done judiciously they can lead to a very artificial look which, ironically, makes women look much older," Dr. Tanzi said. "As thoughtful physicians, it’s important to keep perspective and guide patients to know when enough is enough [in terms of procedures]," she added.
Dr. Tanzi disclosed that she is a consultant for Cynosure/Palomar, Lumenis, and other companies.
DANA POINT, CALIF. – When is someone too young for antiaging procedures with cosmetic fillers or laser resurfacing?
Chronologic age "is somewhat irrelevant," in the opinion of Dr. Elizabeth L. Tanzi, codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery. "I’m looking at dermatologic age, with a critical evaluation of [a patient’s] need," she said at a meeting sponsored by SkinCare Physicians and Northwestern University.
Dr. Tanzi noted that genetics also plays a role in how each person’s skin ages over time. "Some people have inherited facial expressions," she explained. "They may get hyperdynamic movement in certain parts of their face and develop wrinkles much earlier than you would anticipate. Environmental exposure clearly plays a large role. Excessive ultraviolet exposure, growing up with outdoor sporting activities, tanning bed use, or poor habits such as smoking are going to lead to an accelerated aging process," she said.
The importance of establishing realistic patient expectations starts with the first office consultation, when clinicians emphasize that "we can slow down the signs of aging on your skin, but we cannot stop the process completely," said Dr. Tanzi, who is also an assistant professor of dermatology at George Washington University Medical Center, Washington. "I think it’s more important to talk about looking youthful, energetic, and vibrant, not necessarily looking young, because we may be inadvertently delivering the wrong message – that all aging is preventable if treatments are started early enough – and that sets the stage for unrealistic expectations."
Encouraging sun protection behaviors is sensible, and "most dermatologists realize that you can use neuromodulators and fillers strategically early on," Dr. Tanzi said. "But the idea of using fractionated laser resurfacing treatments to promote improved skin function is intriguing to me. We know we can improve the skin cosmetically through a series of fractional laser resurfacing treatments. But can we functionally improve the skin as it’s aging?" she questioned.
Cutting-edge research suggests that may be the case. In 2012, Dan F. Spandau, Ph.D., and his colleagues (J. Invest. Dermatol. 2012;132:1591-6) published data showing that dermal wounding procedures such as fractional resurfacing can "wake up senescent dermal fibroblasts to produce more insulin-like growth factor-1 (IGF-1), which helps the epidermis ward off the damaging effects of UVB on the skin," Dr. Tanzi said. In that case, she continued, "should we be recommending fractional resurfacing as part of a healthy antiaging routine? If so, at what age? These are exciting developments that need additional research to help guide new treatment protocols."
Although she is enthusiastic about preventing some signs of aging and helping patients maintain a youthful appearance, Dr. Tanzi expressed some concerns. "If we are not careful, we could be setting ourselves up for an expectation of being able to stop the aging process, and this can be a slippery slope, especially for women," she said. "Especially when it comes to fillers and neuromodulators, if not done judiciously they can lead to a very artificial look which, ironically, makes women look much older," Dr. Tanzi said. "As thoughtful physicians, it’s important to keep perspective and guide patients to know when enough is enough [in terms of procedures]," she added.
Dr. Tanzi disclosed that she is a consultant for Cynosure/Palomar, Lumenis, and other companies.
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The New Frontier of Health Care
PODCAST: An Inside Look at Medication Reconciliation
This month’s feature highlights an initiative of the Society of Hospital Medicine aimed at helping hospitalists drive team-based medication reconciliation programs.
Dr. Jeffrey Schnipper, director of clinical research for the hospitalist service at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, both in Boston, discusses the opportunities and challenges of med-rec and why he thinks med-rec shouldn’t be viewed as just a regulatory issue.
Dr. Stephanie Mueller, a clinician investigator and hospitalist researcher at Brigham and Women’s Hospital, talks about how MARQUIS components were developed and the role patients can play in med-rec. Dr. Amanda Salanitro, a hospitalist at the VA Tennessee Valley Healthcare System and an instructor at Vanderbilt University, both in Nashville, shares why she sees accountability as a critical component of med-rec quality improvement and her thoughts about how IT can help the process.
Click hear to listen to our medication reconciliation podcast.
This month’s feature highlights an initiative of the Society of Hospital Medicine aimed at helping hospitalists drive team-based medication reconciliation programs.
Dr. Jeffrey Schnipper, director of clinical research for the hospitalist service at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, both in Boston, discusses the opportunities and challenges of med-rec and why he thinks med-rec shouldn’t be viewed as just a regulatory issue.
Dr. Stephanie Mueller, a clinician investigator and hospitalist researcher at Brigham and Women’s Hospital, talks about how MARQUIS components were developed and the role patients can play in med-rec. Dr. Amanda Salanitro, a hospitalist at the VA Tennessee Valley Healthcare System and an instructor at Vanderbilt University, both in Nashville, shares why she sees accountability as a critical component of med-rec quality improvement and her thoughts about how IT can help the process.
Click hear to listen to our medication reconciliation podcast.
This month’s feature highlights an initiative of the Society of Hospital Medicine aimed at helping hospitalists drive team-based medication reconciliation programs.
Dr. Jeffrey Schnipper, director of clinical research for the hospitalist service at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, both in Boston, discusses the opportunities and challenges of med-rec and why he thinks med-rec shouldn’t be viewed as just a regulatory issue.
Dr. Stephanie Mueller, a clinician investigator and hospitalist researcher at Brigham and Women’s Hospital, talks about how MARQUIS components were developed and the role patients can play in med-rec. Dr. Amanda Salanitro, a hospitalist at the VA Tennessee Valley Healthcare System and an instructor at Vanderbilt University, both in Nashville, shares why she sees accountability as a critical component of med-rec quality improvement and her thoughts about how IT can help the process.
Click hear to listen to our medication reconciliation podcast.
Data Mining Expert Explains Role Performance Tools Will Play in Future
Click here to listen to more of our interview with Paul Roscoe, CEO of the Washington, D.C.-based Advisory Board Company
Click here to listen to more of our interview with Paul Roscoe, CEO of the Washington, D.C.-based Advisory Board Company
Click here to listen to more of our interview with Paul Roscoe, CEO of the Washington, D.C.-based Advisory Board Company
The Why and How Data Mining Is Applicable to Hospital Medicine
Click here to listen to excerpts of our interview with Dr. Deitelzweig, chair of SHM’s Practice Analysis Committee.
Click here to listen to excerpts of our interview with Dr. Deitelzweig, chair of SHM’s Practice Analysis Committee.
Click here to listen to excerpts of our interview with Dr. Deitelzweig, chair of SHM’s Practice Analysis Committee.
Learn How Best To Avoid Some of Data Mining’s Potential Pitfalls
Ensuring data quality and equivalency can present major challenges in data analytics, especially given the field’s dearth of uniform standards.
“The joke is that the great thing about health-care data standards is that there’s so many to choose from,” says Brett Davis, general manager of Deloitte Health Informatics. If data integration remains a big challenge, however, Davis says the cost and complexity of the technology is dropping rapidly.
A lack of electronic health records (EHR) can limit more advanced data-mining functions. But that’s no excuse for not exploring the technology, says Steven Deitelzweig, MD, SFHM, system chairman for hospital medicine at Ochsner Health System in New Orleans and chair of SHM’s Practice Analysis Committee.
Deployment of that partial prerequisite also seems to be happening quickly around the country. The Office of the National Coordinator for Health IT (ONC) estimates that hospital adoption of at least a basic EHR system more than tripled between 2009 and 2012, to 44% from 12%. Meanwhile, an estimated 85% of hospitals were at least in possession of certified EHR technology by 2012.
Despite the falling barriers, Davis cautions that users should have clear goals in mind when setting up a new system. “There is the risk of building bridges to nowhere, where you just integrate data for the sake of integrating data but not knowing what questions and insights you want to glean from it,” he says.
ONC spokesman Peter Ashkenaz agrees, citing governance within a hospital or health center and education of all participants as important elements of any data-analytics plan. Among the questions that must be addressed, he says, are these: “Have we collected the right information? Are we doing so efficiently and securely with respect to privacy requirements? Are we sharing the data with the appropriate parties? Are we doing so in a way that is easily understood? Are we asking the right questions about how to use the information?”
The most fundamental question, Dr. Deitelzweig says, may be whether a hospitalist group, hospital, or health system is truly committed to using the technology. “If you’re going to make the investment in such things, then you really better be dedicated to understanding them and how best to utilize them. And give it some time,” he says. “I think people want solutions fast, and often they don’t take the time to individualize it or customize it.” TH
Bryn Nelson is a freelance medical writer in Seattle.
Ensuring data quality and equivalency can present major challenges in data analytics, especially given the field’s dearth of uniform standards.
“The joke is that the great thing about health-care data standards is that there’s so many to choose from,” says Brett Davis, general manager of Deloitte Health Informatics. If data integration remains a big challenge, however, Davis says the cost and complexity of the technology is dropping rapidly.
A lack of electronic health records (EHR) can limit more advanced data-mining functions. But that’s no excuse for not exploring the technology, says Steven Deitelzweig, MD, SFHM, system chairman for hospital medicine at Ochsner Health System in New Orleans and chair of SHM’s Practice Analysis Committee.
Deployment of that partial prerequisite also seems to be happening quickly around the country. The Office of the National Coordinator for Health IT (ONC) estimates that hospital adoption of at least a basic EHR system more than tripled between 2009 and 2012, to 44% from 12%. Meanwhile, an estimated 85% of hospitals were at least in possession of certified EHR technology by 2012.
Despite the falling barriers, Davis cautions that users should have clear goals in mind when setting up a new system. “There is the risk of building bridges to nowhere, where you just integrate data for the sake of integrating data but not knowing what questions and insights you want to glean from it,” he says.
ONC spokesman Peter Ashkenaz agrees, citing governance within a hospital or health center and education of all participants as important elements of any data-analytics plan. Among the questions that must be addressed, he says, are these: “Have we collected the right information? Are we doing so efficiently and securely with respect to privacy requirements? Are we sharing the data with the appropriate parties? Are we doing so in a way that is easily understood? Are we asking the right questions about how to use the information?”
The most fundamental question, Dr. Deitelzweig says, may be whether a hospitalist group, hospital, or health system is truly committed to using the technology. “If you’re going to make the investment in such things, then you really better be dedicated to understanding them and how best to utilize them. And give it some time,” he says. “I think people want solutions fast, and often they don’t take the time to individualize it or customize it.” TH
Bryn Nelson is a freelance medical writer in Seattle.
Ensuring data quality and equivalency can present major challenges in data analytics, especially given the field’s dearth of uniform standards.
“The joke is that the great thing about health-care data standards is that there’s so many to choose from,” says Brett Davis, general manager of Deloitte Health Informatics. If data integration remains a big challenge, however, Davis says the cost and complexity of the technology is dropping rapidly.
A lack of electronic health records (EHR) can limit more advanced data-mining functions. But that’s no excuse for not exploring the technology, says Steven Deitelzweig, MD, SFHM, system chairman for hospital medicine at Ochsner Health System in New Orleans and chair of SHM’s Practice Analysis Committee.
Deployment of that partial prerequisite also seems to be happening quickly around the country. The Office of the National Coordinator for Health IT (ONC) estimates that hospital adoption of at least a basic EHR system more than tripled between 2009 and 2012, to 44% from 12%. Meanwhile, an estimated 85% of hospitals were at least in possession of certified EHR technology by 2012.
Despite the falling barriers, Davis cautions that users should have clear goals in mind when setting up a new system. “There is the risk of building bridges to nowhere, where you just integrate data for the sake of integrating data but not knowing what questions and insights you want to glean from it,” he says.
ONC spokesman Peter Ashkenaz agrees, citing governance within a hospital or health center and education of all participants as important elements of any data-analytics plan. Among the questions that must be addressed, he says, are these: “Have we collected the right information? Are we doing so efficiently and securely with respect to privacy requirements? Are we sharing the data with the appropriate parties? Are we doing so in a way that is easily understood? Are we asking the right questions about how to use the information?”
The most fundamental question, Dr. Deitelzweig says, may be whether a hospitalist group, hospital, or health system is truly committed to using the technology. “If you’re going to make the investment in such things, then you really better be dedicated to understanding them and how best to utilize them. And give it some time,” he says. “I think people want solutions fast, and often they don’t take the time to individualize it or customize it.” TH
Bryn Nelson is a freelance medical writer in Seattle.
MARQUIS Highlights Need for Improved Medication Reconciliation
What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?
Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.
“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.
“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.
Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.
An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.1
“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.
The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.
Listen to more of our interview with MARQUIS principal investigator Jeffrey Schnipper, MD, MPH, FHM.
Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.
Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.
The MARQUIS toolkit is available on the SHM website. TH
Larry Beresford is a freelance writer in San Francisco.
Reference
1. Schnipper JL, Mueller SK, Salanitro AH, Stein J. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). PowerPoint presentation at Society of Hospital Medicine annual meeting, May 16-19, 2013, National Harbor, Md.
What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?
Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.
“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.
“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.
Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.
An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.1
“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.
The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.
Listen to more of our interview with MARQUIS principal investigator Jeffrey Schnipper, MD, MPH, FHM.
Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.
Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.
The MARQUIS toolkit is available on the SHM website. TH
Larry Beresford is a freelance writer in San Francisco.
Reference
1. Schnipper JL, Mueller SK, Salanitro AH, Stein J. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). PowerPoint presentation at Society of Hospital Medicine annual meeting, May 16-19, 2013, National Harbor, Md.
What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?
Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.
“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.
“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.
Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.
An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.1
“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.
The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.
Listen to more of our interview with MARQUIS principal investigator Jeffrey Schnipper, MD, MPH, FHM.
Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.
Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.
The MARQUIS toolkit is available on the SHM website. TH
Larry Beresford is a freelance writer in San Francisco.
Reference
1. Schnipper JL, Mueller SK, Salanitro AH, Stein J. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). PowerPoint presentation at Society of Hospital Medicine annual meeting, May 16-19, 2013, National Harbor, Md.
The RAC man cometh
If you have never heard of the Recovery Audit Contractor (RAC) program, it’s only a matter of time. A little bit of history is in order here. Between 2005 and 2008, a demonstration program that used Recovery Auditors identified Medicare overpayments, as well as underpayments, to both providers and suppliers of health care in random states. The result was that a whopping $900 million in overpayments was returned to the Medicare Trust Fund, while close to $38 million in underpayments was given to health care providers.
Obviously, this program was a tremendous success for the Centers for Medicare and Medicaid Services (CMS), and it has since taken off in all 50 states. And, you guessed it, it remains a great boon for the Medicare Trust Fund.
In fiscal year 2010, $75.4 million in overpayments was collected, and $16.9 million returned, and in fiscal year 2013, $2.2 billion in overpayments was collected, while $370 million was returned. Since the program’s inception, there has been $5.7 billion in total corrections, of which, $5.4 billion was collected from overpayments.
Surprised? I think most of us, and our hospitals, could benefit by hospitalists learning more about the RAC and what we could do to guard against a successful audit and penalty. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides provider-specific Medicare data stats for discharges and services that are vulnerable. Pepperresources.org was developed by TMF Health Quality Institute, which was contracted by the CMS.
PEPPER has many uses, but one of the most useful for hospitals is to compare its claims data over time to identify concerning trends, such as significant changes in billing practices, increasing length of stay, and over- or undercoding. In 2013, practicing good medicine just isn’t enough. You have to make sure you are documenting appropriately to justify the codes you bill. Outliers beware!
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.
If you have never heard of the Recovery Audit Contractor (RAC) program, it’s only a matter of time. A little bit of history is in order here. Between 2005 and 2008, a demonstration program that used Recovery Auditors identified Medicare overpayments, as well as underpayments, to both providers and suppliers of health care in random states. The result was that a whopping $900 million in overpayments was returned to the Medicare Trust Fund, while close to $38 million in underpayments was given to health care providers.
Obviously, this program was a tremendous success for the Centers for Medicare and Medicaid Services (CMS), and it has since taken off in all 50 states. And, you guessed it, it remains a great boon for the Medicare Trust Fund.
In fiscal year 2010, $75.4 million in overpayments was collected, and $16.9 million returned, and in fiscal year 2013, $2.2 billion in overpayments was collected, while $370 million was returned. Since the program’s inception, there has been $5.7 billion in total corrections, of which, $5.4 billion was collected from overpayments.
Surprised? I think most of us, and our hospitals, could benefit by hospitalists learning more about the RAC and what we could do to guard against a successful audit and penalty. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides provider-specific Medicare data stats for discharges and services that are vulnerable. Pepperresources.org was developed by TMF Health Quality Institute, which was contracted by the CMS.
PEPPER has many uses, but one of the most useful for hospitals is to compare its claims data over time to identify concerning trends, such as significant changes in billing practices, increasing length of stay, and over- or undercoding. In 2013, practicing good medicine just isn’t enough. You have to make sure you are documenting appropriately to justify the codes you bill. Outliers beware!
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.
If you have never heard of the Recovery Audit Contractor (RAC) program, it’s only a matter of time. A little bit of history is in order here. Between 2005 and 2008, a demonstration program that used Recovery Auditors identified Medicare overpayments, as well as underpayments, to both providers and suppliers of health care in random states. The result was that a whopping $900 million in overpayments was returned to the Medicare Trust Fund, while close to $38 million in underpayments was given to health care providers.
Obviously, this program was a tremendous success for the Centers for Medicare and Medicaid Services (CMS), and it has since taken off in all 50 states. And, you guessed it, it remains a great boon for the Medicare Trust Fund.
In fiscal year 2010, $75.4 million in overpayments was collected, and $16.9 million returned, and in fiscal year 2013, $2.2 billion in overpayments was collected, while $370 million was returned. Since the program’s inception, there has been $5.7 billion in total corrections, of which, $5.4 billion was collected from overpayments.
Surprised? I think most of us, and our hospitals, could benefit by hospitalists learning more about the RAC and what we could do to guard against a successful audit and penalty. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides provider-specific Medicare data stats for discharges and services that are vulnerable. Pepperresources.org was developed by TMF Health Quality Institute, which was contracted by the CMS.
PEPPER has many uses, but one of the most useful for hospitals is to compare its claims data over time to identify concerning trends, such as significant changes in billing practices, increasing length of stay, and over- or undercoding. In 2013, practicing good medicine just isn’t enough. You have to make sure you are documenting appropriately to justify the codes you bill. Outliers beware!
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.
