WEEK THREE DISCUSSION #1 This assignment is a 350-word minimum posting

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The Reason We’re All Here …

We continued our drill down into the key concepts of quality and patient safety with a focused look at patient safety, and patient satisfaction.

This session will review how we engage with our physician partners to evaluate their care and methods and tools to engage them in the quality/patient safety process.

HCA 622 Week Three Roadmap

√ Please read Chapters in the required text prior to our class

√ In order to get the most out of the course, pace yourself by completing something everyday

√ Catch up as needed over the weekend

√ All graded assignments must be turned in no later than Sunday at midnight PT each week

HCA: 622 Quality Appraisal and Evaluation– WEEK THREE ROADMAP
	Monday	Tuesday	Wednesday	Thursday	Friday	Sat/Sun
Themes	Patient Safety and Medical Errors, Creating a Culture of Safety and High Reliability, Measuring and Improving Patient Experiences of Care		Physician and Provider Profiling, Implementing Healthcare Quality Improvement: Changing Clinician Behavior
Readings	Read Chapters 11, 12, 9, 7, 17 in required text
Film Festivals
Discussion Questions	Complete DQ5		Complete DQ6
Exercises			Reflection Journal Entry #1		Reflection Journal Entry #2
Assessments						Week Three Quiz
Case Studies
Course project						Signature Project Outline Due

Contact Your Professor for Questions

Chapter 7: Physician and Provider Profiling
Chapter Outline

Physician and Provider Profiling
Scope and Use of Profiling in Healthcare
Use in Healthcare Organizations
Implementation: Keys to Success

and Challenges

Physician Profiling in the Era of Healthcare Reform

We have learned how important physician practice is in the care process and how variation in physician practice affects both quality and patient safety.

We will review the processes in place to evaluate physician performance, physician profiling as a key tool in the process, and some keys to successful implementation for the physician profiling process.

Introduction: The Why!

National healthcare spending reached 17.9 percent of the gross domestic product (GDP) in 2011 (Fuchs 2013) and is projected to reach 19.8 percent of the GDP by 2020 (Keehan et al. 2011).
With this increased spending on healthcare, many Americans are beginning to question whether they are receiving appropriate quality and value for their healthcare dollars
Because of the significance of reports like the IOM report, re: problems with medical errors and adverse events, the govern- ment, employers, and the public are concerned about the effects of suboptimal care and demanding more affordable healthcare of the highest quality.

We have spent time in almost all of our sessions reviewing the statistics related to the quality, cost and the need for improvement in the United States’ approach to quality and safety.

The efforts to improve our key processes of care must include the evaluation and improvement of physician performance if we are to be successful in our efforts.

Introduction: The Why!

Physicians’ practice patterns have been shown to be a major contributor to unexplained clinical variation in healthcare.
Unexplained clinical variation exists among providers by specialty, geographic region, and practice setting and is not associated with better quality of care and health outcomes (Skinner and Fisher 2010).

As we have heard in our course work, specifically through the TED talks presented by our physician patient safety leaders, variation in physician practice patterns is a key factor in patient safety as well as the cost of care.

Physician and Provider Profiling- The How!

Physician profiling is the collection of provider-specific and practice-level data used to analyze physician practice patterns, utilization of services, and outcomes of care.
The goals for physician profiling are to
improve physician performance through accountability and feedback
decrease practice variation through adherence to evidence-based standards of care
Profile development enables a physician’s treatment pattern to be assessed.

Physician profiles provide us with a way to review key practice-level data to analyze physician practice patterns, utilization of services and outcomes of care in order to improve accountability and decrease variation in care.

Scope and Use of Profiling in Healthcare

Value-based purchasing
Continuous quality improvement (CQI)
Credentialing
Outcomes management
Physician report cards
Benchmarking
Clinical pathways

Physician and Provider Profiling

Value-Based Purchasing

Healthcare buyers are beginning to use value-based purchasing to make healthcare decisions.
Employers are interested in cost, outcomes, and value.
Efforts to determine quality measures for hospitals and health plans are being expanded to include physicians.
Public reporting!

Value-based purchasing

Use for value-based purchasing, which utilizes hospital data for reimbursement of good results (and a decrease in reimbursement for poor results against benchmarks) and is publicly reported.

The data on physician performance is being collected, but has not yet been used or publicly reported. The next step in the value-based process is for the sharing of physician data to also be used and shared with the public.

Physician and Provider Profiling

Tools organizations use as part of their continuous total quality management strategy:

Credentialing: process of hiring well-qualified medical staff able to deliver the highest quality of care

Outcomes management: relationship between outcomes in clinical research and patient satisfaction

Physician report cards: compare physicians on outcomes related to such factors as patient satisfaction and cost utilization patterns to change physician behavior

Benchmarking: encompasses the use of quantitative measures of best practices to compare individuals’ performances
Clinical pathways: treatment plans designed to reduce variation in clinical guidelines and protocols and facilitate their implementation - are they using them?

Credentialing

There is a mandated process in place for initial appointment and ongoing review of physicians (similar to HR processes) called credentialing. At the time of initial entrance onto the medical staff, and at least every two years, the data on physician performance is reviewed by physician peers and evaluated for comparison with other physicians, locally, regionally and nationally. The use of profiles is emerging as key tool in that process.

Physician and Provider Profiling

Effective Profiles

Effective profiles should document variations in provider performance on individual, local, and national bases.
Profiles motivate competitive physicians to improve areas in which they rank low when compared to a group of peers.
Profiles should be easy to understand and provide the physician with suggestions for improvement.

The effectiveness of the profiles depends on their use for benchmarking, ease of use and a clear way of presenting opportunities for improving performance.

Use in Healthcare Organizations

Physician profiles are a valuable educational tool.
Physician profiling is one of the many tools used in CQI.
Numerous studies have documented that, when presented with information on their performance relative to that of their colleagues, physicians will change their behavior to meet a specified outcome.
The most effective profiles document variations in provider performance on an individual, local, and national basis.

Report cards, benchmarking and the use of clinical pathways

The profile allows an organization to view the physician’s performance against others, and including how they are utilizing clinical pathways, or evidence-based practices in their care.

The profiles are excellent tools when used for education, and engaging physicians in the team processes of care.

Future Technology

The creation of an information technology infrastructure to analyze the performance of all physicians in a healthcare system can be useful in identifying the conditions the hospital, physician, or physician group treats most.
EHRs can be valuable in creating disease registries and in giving physicians an overview of patient outcomes at the population level.

As technology and the use of electronic medical records is more widespread, the availability of relevant data will be more prevalent and useful.

Use in Healthcare Organizations - How?

A quality improvement committee should
identify the areas most appropriate for profiling and the areas in which it wants to improve performance;
identify the techniques it will use to gather and disseminate data;
develop an objective and appropriate way to interpret the results;
communicate the results in a way that will be most valuable for physicians; and
schedule meetings on a monthly or quarterly basis so that physicians have the opportunity to provide input on how the profiling system is working.

The use of physician profiles is relatively new to the quality process for physicians. Assuring the success of their implementation and use can be enhanced by the following steps:

A quality improvement committee made up of key physician leaders and quality support staff should:

identify the areas most appropriate for profiling and the areas in which it wants to improve performance;