Re: CAMTS

["David A. Summers" <copterrn@bellsouth.net>]

interesting dialog, some truth, some not.

david

Paul M. Wright, Jr. wrote:

> 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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>
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