Addiction Medicine Faces Challenge of Developing Quality Standards

A discussion of the effect of health system reform and the need for quality standards for addiction medicine drew a large crowd to Symposium 2 Friday.

A discussion of the effect of health system reform and the need for quality standards for addiction medicine drew a large crowd to Symposium 2 Friday.

The Affordable Care Act promises to bring more support for addiction treatments, but that funding comes with requirements for setting and meeting standards of care. A symposium Friday examined expectations of federal agencies for quality standards and ASAM’s plans to develop addiction medicine treatment standards.

Symposium 2, “Clinical Quality Measurement in Addiction Medicine,” featured four presentations that looked at different aspects of quality measures, followed by a panel discussion with questions from the audience about the plans of ASAM’s Practice Improvement and Performance Measurements Action Group (PIPMAG).

H. Westley Clark, MD, JD, MPH, CAS, FASAM; Director, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA) discussed the needs of regulating agencies.

“In less than eight months, you are going to have a lot of people presenting for treatment. If you accept federal funds, you are stuck with the federal lens that scrutinizes what you do,” he said in referencing requirements of the Affordable Care Act that take effect in January 2014.

“You have to address the question of what you are doing. You need to quantify that. It is not good enough to say ‘It’s just my training.’ The question is ‘Why are you treating that person the way you treat them?’ and you need to document that. It is important for us to adhere to standards of care and performance.”

Another piece of the changes is that primary care and specialty care will soon be partners, Dr. Cark said.

“That presents a challenge in dealing with consistent care and quality measures. This is significant as we move to more integrated models of care,” he said, adding that the future holds physicians working together in patient-centered medical homes and accountable care organizations.

To meet that challenge of documenting that addiction medicine physicians are meeting standards of care, ASAM developed PIPMAG, which is chaired by Michael M. Miller, MD, FASAM, FAPA, Medical Director, Herrington Recovery Center, Rogers Memorial Hospital.

Because of the afflictions it treats, addiction medicine lags behind other specialties in being able to document its performance, he said. The first step in the documentation process is to develop standards.

“Do you practice quality medicine? How do you know? You can’t just say it works,” he said. “You have to measure a baseline. Performance measures are metrics. You have to measure the frequency with which physician and others adhere to practice processes that have been deemed to be best practices via practice guidelines.

“But they are not practice guidelines—which generally are developed by professional specialty societies based on extensive literature review and a ‘grading of evidence.'”

The PIPMAG committee started the process of developing standards by making assumptions about what defines high-quality practice, Dr. Miller said. The committee has set a timeline for this year to review those assumptions and then take action to establish standards of care.

“We realized our field does not have the starting point of orthopedics or pediatrics with regard to well-developed practices guidelines,” he said, adding that addiction medicine must now work hard to catch up.

Margaret Jarvis, MD, FASAM, Clinical Assistant Professor at Penn State University, is now a member of a PIPMAG committee working on the development of standards. The committee has developed domains for standards, and now the details of those domains must be added.

“They must be written broadly enough to cover a number of different kinds of practices and philosophies of practice,” she said.