|
|
November 27, 2006
Before the end of 2006, your paper medical records may put a serious dent in your practice’s productivity. That’s because one fourth of Americans will be affected by President Bush’s August 22 Executive Order requiring federal agencies to give healthcare consumers greater access to information about the cost and quality of healthcare services. According to the White House, the goal of the Executive Order is to promote price transparency, quality transparency, the adoption of IT standards, and healthcare quality improvement (QI). The Executive Order requires four federal agencies—Health and Human Services (HHS), the Department of Defense, the Department of Veterans Affairs, and the Office of Personnel Management—to collect information about the quality and price of healthcare then share that data with each other and with those who participate in their programs. The order requires the four agencies to implement it by January 1, 2007. The patient population includes Medicare beneficiaries, retired and current federal employees, veterans, and members of the military. All totaled, that’s roughly one in four Americans. If those patients fall within your population, the principles of transparency are about to become your catalyst for change. A Clear Look at Transparency At the top of many clinicians’ list of concerns about transparency is what data source will be used for measurement. Where did the data originate, how was it analyzed, and how will it help patients? Achieving cost and quality reporting first requires a sophisticated data gathering and reporting infrastructure to be in place, one that is still fairly immature in many states. Will data come from payors, billing services, consumers, or physicians? The bottom line is that the entities in your health community which help you gather, analyze, measure, and process quality and cost data about your practice are about to become your business VIPs— very important partners. Thus far, it looks like cost and quality-of-care data used to analyze your practice will come from payors. Putting Transparency to
the Test • reduce healthcare costs? • reduce the number of uninsured Americans? • result in better quality healthcare? • preserve economic competitiveness and stabilize the price of health technology? PBGH, selected as one of six pilot sites, is a statewide initiative that promotes collaboration instead of competition in health plan and provider-level data collection and performance reporting. The other sites are in Arizona, Indiana, Massachusetts, Minnesota, and Wisconsin. Through its California collaboration, PBGH has been gathering and reporting quality information to consumers using results from a comprehensive 2005 study conducted by the California Cooperative Healthcare Reporting Initiative and supported by PBGH. Medical group quality measures were based on the patient-reported experiences of care and service for adults aged 18 and older who were commercially insured health maintenance organization members. A number of the survey questions were organized into sets of related topics. Of the topics that were evaluated, the following five were chosen as the best indicators of performance: • patient rating of care; • communicating with patients; • getting treatment and specialty care; • timely care and service; and • coordinating patient care . The end result is that Californians now use the study results to compare quality information about healthcare providers to evaluate what their experience may be like with a medical group. At www.healthscope.org/med_groups/default.asp, for example, consumers can compare quality reporting on medical groups such as the ones featured in Figure 1. Quality Ratings PGBH cautions consumers to also review the ratings of health plans since the plan influences the care they will receive from the practice. In researching this and similar quality reporting sites, I found an overlap between quality reporting and modules that improve patient communication and office efficiency included in most electronic health record (EHR) software. Data stored on paper is difficult to analyze, leaving research to anecdotal incidents or stories exchanged by patients, which doesn’t necessarily reflect true cost or quality of care. Clinical vs. Payor Data to Prove
Quality Frequently, they found that data used to measure their performance was flawed. So, the practice developed a quality improvement tool with more than 50 indicators drawn from JCAHO, the CMS, and the Institute of Medicine. The tool measures quality in four categories: • patient satisfaction; • efficiency; • practitioner performance; and • clinical quality indicators. An independent audit revealed that 100% of the clinical data capture was statistically valid and was based on incidence rather than anecdotes. The critical outcome for the practice was to enfranchise physicians, certified registered nurse anesthetists, and registered nurses (post-anesthesia recovery unit, continuous quality improvement), then review and suggest improvement. “If you want to affect change in physicians, you have to use believable data,” says Gilbert. “Believable data to a physician is clinical data, not data that has been scrubbed, processed, or reformatted.” Not only did the physicians find areas to improve, they also generated monthly quality reports which they provided to SAC’s corporate continuous quality improvement committee, best practices committee, and clinical chiefs. They also provided feedback on a continual basis to the physicians, along with scorecards. “Most often, a low score was a result of a system problem, so we looked at the communications and workflow system as well as the physician’s performance to fix the problem,” Gilbert says. Through a comprehensive marketing/communications effort, the physicians then developed custom reports and provided them to the hospitals where they practice, shared results with patients, and posted patient satisfaction results on its Web site, www.seanesthesiology.com. Executive Order, Transparency,
Interoperability, and Incentives • implement the Executive Order; • designate the ambulatory quality assurance and the hospital quality assurance as arbitrators of quality care standards; • build a network of quality and price information collaboratives; • engage QI organizations; • attract the support of large employers, states, unions; • accelerate the creation and adoption of HIT standards; • develop standards that enable the gathering of quality and price information from private and public sectors; • provide education and incentives to stimulate adoption and drive change; and • develop pay-for-performance incentives. The transparency order may be just the incentive needed to get physician practice leadership up and running on EHRs. Are physician practices required to get an EHR? No. But in the months that follow, expect to see a rapid uptick of healthcare providers independently posting their prices and quality-of-care indicators online. And that will come from data they gathered themselves. — Carolyn P. Hartley is president and CEO of Physicians EHR, LLC in Cary, N.C. (www.physiciansehr.com), and is coauthor of EHR Implementation: A Step-by-Step Guide for the Medical Practice.
• provide information about the quality of care delivered by physicians and hospitals; • provide information about the prices paid for
services rendered by those providers; • use performance information to reward consumers who make decisions based on value and quality of care and providers who offer such information. The Executive Order requires the four agencies to implement the directives by January 1, 2007. — CPH
|
 |