RE: CAMTS

["Paul M. Wright, Jr." <pmwright@home.com>]

It's an interesting question, both from a safety perspective and
a clinical practice perspective.  As a longtime observer of the
industry, I seriously doubt that one could demonstrate a "cause
and effect" relationship between accreditation and either perspective.

However, it may be that there is a positive correlation between
accreditation and various measures of safety or efficacy because
the decision to seek accreditation involves a high-level committment
of time and resources to an intangible goal.  It is likely that many
such organizations will also make committments of time and resources to
other intangible goals like safety and/or superior patient care.

It has also been my experience that new programs are the most likely
to succumb to competitive pressures to cut corners on safety and
patient care.  Since accreditation requires operating time to acquire
and is not therefore available from day one, there could conceivably
be an advantage to CAMTS-accredited programs by virtue of their
operating history alone.  This could, for example, explain the
advantageous loss ratio that is reflected in the insurance discount
offered to CAMTS members.

However, I also possess a certain cynicism about the meaning of
accreditation.

First of all, the primary driving force behind the
accreditation process is all too often an external motivation rather
than a sincere desire for self-improvement.  This
could be anything from financial incentives such as reduced insurance
rates to increased reimbursement rates to meeting a regulatory
requirement for doing business with a particular agency or within a
particular region.

In that context, the accreditation process may consist largely of
plagiarizing or outright stealing the accreditation documents and
then getting your program's ducks in a row just long enough to get
through the site visit making it appear that the documents reflect
the reality of your day-to-day operations.  As soon as accreditation
is awarded, it's back to business as normal.  This sort of behavior
is not unique to the medical transport industry (think JCHO,
ISO9001, driver's license,etc.) and it just reinforces the idea
that accreditation or certification or whatever term you want to use
is a "snap-shot" event that demonstrates compliance only as of the
date of review.

Second, an accreditation is only as valuable as the resources available
to defend it against mis-use.  I have seen little evidence that CAMTS
has the budgetary resources to take the legal risk of revoking an
accreditation when such action would otherwise seem appropriate.  Last
I recall, the entire annual budget of CAMTS was insufficient to
provide adequate legal defense for even one such contested revocation.
Never mind having the resources to adequately pursue programs that
fradulently claim CAMTS accreditation either by stealing the trade-marked
name of a CAMTS-accredited member or misrepresenting their relationship to
a CAMTS-accredited member.

HOWEVER, that having been said, I'm glad that there is a CAMTS but I think
the value of the accreditation would be vastly increased if they had the
budget to protect the accreditation more vigorously and screen candidates
more thoroughly.  And that would necessarily mean that accredited and
candidate programs would have to cough up even more money than they now do.
It's a matter of conjective as to how willing they would be to do so.  But
until there is more aggressive enforcement, the CAMTS directory will include
a majority of programs that soar like eagles but a few that simply make
droppings like pigeons and you'll have to depend on independent measures of
quality to sort them out.

As far as the other issue of measurable data, there is a tremendous amount
of data out there but the problem is retrieval, access and fair use.  And,
unfortunately, I think we're headed in the wrong direction, particularly
in the for-profit and highly competitive programs.  What I'm seeing more and
more is organizations taking the position that their financial and outcomes
data represent private and proprietary trade secrets.  I've even seen this
carried to the extreme of a claim by a national air medical company that
it's
rates to the public are a private and proprietary trade secret; never mind
its outcomes data, response times, protocols, customer complaint ratios,
etc.
And, of course, putting together a complete longitudinal data trail for a
particular patient has become nearly impossible except in tightly integrated
hospital systems that also operate a medical transport service.

So, for at least the near term, we will continue to know which airline lost
or damaged the most pieces of luggage but we will continue to have no way of
knowing which transport programs lost or damaged the most lives.

I don't have an index with which to measure "superior patient care" but I
will
offer the observation that I think it can only be measured at the level of
the
direct patient-caregiver encounter and not at the program level.  I've seen
some really high-quality programs do some really low-quality things and I've
seen some really high-quality clinicians consistently give excellent patient
care in
spite of being employed by a subprime transport program.

I definitely think that administrative values have a role to play but as a
clinician, I hold myself fully accountable for the care I give and prefer to
measure it at that personal level.  At the program level, such measures
often
give rise to meaningless proclamations like "We're the BEST!" and over time
we begin to believe our own hype.  And that's when the real problems start.

Okay, this was probably far more thoughts than were requested so I'll yield
the podium and go back to listening.

regards!

paul


Paul M. Wright, Jr.
Mesa, AZ








> -----Original Message-----
> From: DPHMICN@aol.com [mailto:DPHMICN@aol.com]
> Sent: Wednesday, January 24, 2001 10:40
> To: flightmed@flightweb.com
> Subject: Re: CAMTS
>
>
>
> In a message dated 1/24/2001 17:34:06, OOPSMD@aol.com writes:
>
> << Now that CAMTS claims that thier programs are considered
> safer by the
> insurance industry--the next logical question is:
>
> Do CAMTS certified programs provide superior patient care
> than those not
> certified?? >>
>
> An interesting idea. I'm not sure how you validate
> 'superior'. Lower cost?
> Lower mortality? More satisfied customers?....
> Any ideas?
>
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