Quality Talk

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Shari Ling, M.D., serves as Deputy Chief Medical Officer for the Centers for Medicare & Medicaid Services’ (CMS) Center for Clinical Standards and Quality. She is responsible for assisting the CMS Chief Medical Officer in the agency’s pursuit of better patient care, healthier populations and communities, and lower costs through quality improvement. Dr. Ling’s long-standing focus is on achieving better health outcomes across the continuum of care through the delivery of high quality, beneficiary-centered care. She has a special interest in the treatment of people with multiple chronic conditions and functional limitations, as well as in reducing health disparities. She is a trained geriatrician and rheumatologist, a part-time faculty member at the Johns Hopkins University School of Medicine, and a volunteer with several medical clinics.

Your training and experience in rheumatology and geriatrics uniquely position you as an advocate for the health of Medicare beneficiaries. How does your clinical background influence your role as Deputy Chief Medical Officer?

My clinical background helps keep me focused on what the real prize is – looking after the care of beneficiaries in the best way that we can. My background includes clinical research training, so I know that evidence really matters. Taking a system-level approach is the most effective way to provide care. I keep these basic premises in mind when I am dealing with program challenges. Our ultimate goal is to provide the best care for beneficiaries and place their concerns at the forefront of our work.

What's in your portfolio as Deputy Chief Medical Officer? How has your previous CMS experience prepared you to span quality and coverage?

My portfolio is pretty broad and all-encompassing, focused on providing support to the agency in a way that both backs up and complements Chief Medical Officer Patrick Conway. My involvement with CMS’ quality measurement group has helped me keep quality top-of-mind. The concepts of quality and coverage are both based on evidence, which constantly needs revisiting as it evolves. I approach matters from the perspective of pursuing the best quality of care for beneficiaries. In addition, I participate in a few U.S. Department of Health and Human Services-level programs and initiatives, including the National Alzheimer’s Plan and the initiative seeking to reduce or prevent Healthcare-Associated Infections (HAIs).

What excites you the most about working with the QIO Program?

What most excites me is the opportunity for driving improvements in outcomes that really matter for beneficiaries. QIOs have been very successful in effecting changes that are evidence-based and that feature innovative approaches to solving problems and improving care delivery. 

Before you took on your current role, you practiced as a geriatrician and you led long-term care measurement efforts for CMS’ Quality Measurement & Health Assessment Group. How can engaging in QIO improvement initiatives benefit both nursing homes and their residents?

The care of nursing home residents is particularly important to me because they represent one of the most vulnerable components of the Medicare and Medicaid populations. Quality improvement and quality measurement are both central to developing, implementing, tracking and improving changes that make a big difference in the daily lives of residents. The work of QIOs is key to implementing and managing cultural change at nursing homes. Eliminating off-label drug use, reducing hospital readmissions and preventing falls at long-term care facilities require system-level and structural change on-site. We have many opportunities to do a better job in these areas and to build on the successes of QIOs and the Advancing Excellence campaign.

In previous interviews, you've noted that CMS is adopting a coordinated approach across health care settings to promote influenza vaccinations for Medicare beneficiaries. How can QIOs, providers and community partners best work with CMS to achieve maximum vaccination rates?

I think there’s an opportunity to really partner with communities. Vaccinations can be delivered in public health settings, including clinics, pharmacies, etc., and therein lies the answer to how we can involve and enlist the community’s support. We need to focus on how the community can engage and encourage the vaccination of beneficiaries. We also need to ensure that we immunize the maximum number of people, including health care workers, children and others whose vaccination potentially will contribute to the protection of Medicare beneficiaries. Getting communities involved is an area where QIOs can really show leadership and action. The other opportunity for them is to find out where there’s variability or disparity in the performance of vaccinations by geographical location or ethnic group. QIOs can be a significant and meaningful partner in this regard.

HAI prevention has been a major area of focus for you, and it's a key issue that QIOs are addressing. What is one key piece of advice you have for a QIO staffer, or anyone else for that matter, working to prevent HAIs at the community level?

My key piece of advice would be to be observant, curious and specific. When we’re looking for opportunities to improve and prevent HAIs, it’s entirely possible that simply by being observant, we can identify a practice pattern that could effectively prevent HAIs within the community. While we typically like to focus on developing evidence-based strategies, sometimes there are faint signals that can be detected by someone like a hospital administrative staff person or a family member. We should always encourage observation and inquiry. 

Anything else you’d like QIO News readers should know?

The reason I’m here doing what I do is because the care and outcomes of beneficiaries really matter to me. I think we have an incredible opportunity and yet a big challenge immediately before us. We can meet the challenge and succeed due to our motivation and our proven tools and skill sets; however, we need a concerted, collaborative effort that involves communities, partners, patients and their families.