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| Archive : Fall
2006 |
FOR A FIVE-STAR RATING AND MAYBE A SMALL BONUS, DOCS MUST:
Track dozens of performance measures // Sift through hundreds of patient records // Swallow thousands of dollars in overhead costs—when all they want is to deliver better care.
The Quest for Quality [page 2]
 By Linda Keslar |
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Yet Congress, fearing a future in which Medicare devours an ever larger share of the federal budget, is tired of waiting for consensus. A bill introduced last year could make performance measures permanent and require mandatory compliance. “Once Medicare gets into the game, that will be the game,” says Hoangmai Pham, a physician and senior health researcher at HSC. Pham notes that Medicare influences the entire health system, with virtually every commercial insurer following the government program’s lead. She predicts that if Medicare adopts P4P, choosing not to participate may cease to be an option for most physicians.
As the P4P juggernaut gains momentum, doctors worry about a range of issues. First among those is where quality measures should come from—self-appointed “experts,” employers, the government, physician specialty groups or broader physician organizations. Then there’s the expense and effort of collecting the data, particularly in the solo and small group practices that make up the bulk of medical providers in this country. Should performance information about individual physicians, doctor groups and hospitals be made public, or would such “report cards” only penalize those who take care of older, sicker populations? Should efficiency be part of the P4P equation? And most essentially: Does P4P really accomplish its dual goals of controlling costs and improving the quality of care?
In 1911, Ernest A. Codman, a surgeon at the Massachusetts General Hospital, opened his own private facility, which he called the End Result Hospital. The name reflected Codman’s obsession with knowing the long-range impact of each patient’s care and with learning from mistakes to improve medical quality. During the next five years, Codman tracked 337 patients admitted to his hospital, recording errors in diagnosis and treatment, and following the patients long after discharge to evaluate the ultimate results of their care. In the hospital’s annual reports, Codman tallied mistakes, and he even offered to refund doctors’ professional fees to patients who had an unsatisfactory result. Then he sent the reports to hospitals around the country, encouraging doctors to follow his lead. Now, almost a century after Codman’s earliest efforts, employers, health plans and consumers have taken up his quest, demanding to know what they’re getting for their health-care dollars and forcing the medical profession to get with the program.
At Park Nicollet Health Services in Minneapolis, tracking performance and results has become a daily concern. The group’s 600 doctors are involved with multiple P4P initiatives, including those sponsored by Medicare and BTE, and must report on a whopping 134 patient-care measures related to breast cancer screening, diabetes care, the management of cholesterol, heart attacks, pneumonia, hip and knee replacements and the use of antibiotics, among others.
“It has been a lot of slow, hard work to get the systems in place,” says Nancy Jarvis, director of informatics at Park Nicollet. “Our medical group must look at so many measures, it can be overwhelming.”
Since 2002 the 3,000-plus physicians of Rochester Individual Practice Association (RIPA) in New York have worked with Excellus BlueCross BlueShield to report on a dozen performance measures linked to quality, affordability and patient satisfaction in the care of diabetes, asthma and heart disease. While the group has recorded improvements in every category, Howard Beckman, medical director of RIPA, cautions against reading too much into this early success—and in particular, against using the performance measures to judge whether particular doctors are good at what they do. He especially opposes one of the primary goals of many P4P programs: making doctor report cards public. “I think the pretense of giving people reports from which they’re supposed to figure out who’s a good doctor—well, it’s impossible based on the measures available.” |
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Photo by Sarah A. Friedman |
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