ASAM Leading Development of Practice Standards, Performance Measures


Component Session 3, presented Thursday night, addressed the establishment of practice standards and performance measures for addiction physicians.

In 2014, U.S. health care professionals are increasingly expected to meet standards of care and measure patient outcomes to gain optimal reimbursement from government and private payers. ASAM is taking a lead role in establishing standards and measures for addiction medicine to meet these demands.

An overview of the recently published Standards of Care for Addiction Specialist Physician and a look at the work on developing performance measures was presented Thursday during Component Session 3, “Quality Improvement: Improving Patient Care with Standards, Performance Measures and Guidelines.”

“ASAM, with support of SAMHSA and other federal agencies, is trying to move addiction medicine into the area of quality measurement, which is where the rest of medicine is,” said Michael Miller, MD, FASAM, ABAM Diplomate, Chair of the Practice Improvement and Performance Measurement Action Group (PIPMAG) overseeing the work. “In all of medicine there is a real push for accountability and demonstration of results. To say a treatment works or that you are a good provider is not enough; you have to show evidence that it works and that you are a good provider.”

The first step was to establish standards of practice, an effort that has been led by Margaret Jarvis, MD, FASAM, ABAM Diplomate, Medical Director of Marworth Treatment Center, Waverly, Pennsylvania. Work on writing those standards started in late 2012, and they were published on the ASAM website in March.

“We were charged with describing the most basic behaviors that an addiction physician would do with a patient,” she said. ‘There is language in the standards that says these are the basics you have to meet to do a competent job. We describe what physicians would do from the moment they see a patient, how to begin to assess them, how you go about assessing them, what needs to go into treatment planning, and what needs to go into care transitions.”

The practice standards have five modules that detail the work of an addiction physician across all types of practices in all types of settings.

“We tried to be mindful that this is not a guideline,” Dr. Jarvis said. “In a guideline, you get specific recommendations for specific situations. A standard is not intended to be that. This piece needed to describe behavior from a mile-high view and not get into the weeds with it. There are a few places where it was necessary to spell things out—as in the assessment piece about what needs to happen in taking a history and conducting an examination of the patient. That is a comprehensive list.”

The standards of practice provide the foundation for a second PIPMAG group that is working to define domains for performance measures. That group is led by R. Corey Waller, MD, MS, Director of the Center for Integrative Medicine at Spectrum Health, Grand Rapids, Michigan.

“Creating performance measures, quality measures and standards of care allows us to know that the patient and the system are both getting really good value for the service, if someone is meeting all of these performance and quality measures.” Dr. Waller said.

“It also allows us a way to determine and monitor certain behaviors we know lead to improved care,” he said. “Adopting these standards of care not only allows us to monitor physician performance, but allows us to explain the value proposition of what we do.”

The component session also addressed ASAM’s work with SAMHSA to steward measures of physician performance until they are adopted by public entities in health care that measure quality, such as the Centers for Medicare and Medicaid Services and the National Quality Forum.

“There is a performance measure that has been drafted, and ASAM has not drafted it, but we have been asked to steward the measure so it could be widely adopted. Only a specialty society can do that,” said Dr. Miller, Medical Director of the Herrington Recovery Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin.

“We are going to steward, or shepherd, this measure for SAMHSA, and later there may be other measures developed by other entities, such as academic institutions or governmental institutions, so that ASAM may develop expertise in measures stewardship that we could then offer to others in the field,” he said. “The measure we are going to steward for SAMHSA is a composite measure that all together, at once, allows health systems to screen for unhealthy drinking, nonmedical use of prescription drugs, and tobacco use—which is never healthy.”