“I’m a good doctor. Are you?”

Monday, September 01, 2014 12:15 PM

Reporting quality measures to improve care

by Mark A. Levine, MD, FACP, Chief Medical Officer, Denver Centers for Medicare and Medicaid Services

DISCLAIMER: The opinions expressed in this article are the author’s own and do not reflect the view of the Department of Health and Human Services or the Centers for Medicare & Medicaid Services.

I’m frequently asked, “What kind of doctor are you?” I playfully respond, “Why a good one, of course!”

That was easy to say a few years ago, as there was no way to tell. But today I shouldn’t be so cavalier. Anyone with internet access can soon find objective measures of my performance and can decide for themselves how good I really am.⁽¹⁾

Just as the public can access data on physician performance, so can physicians. Physicians can see a rapidly expanding set of data that provides insight into their practice in ways never before possible. Physicians need to embrace this newly available data and use it to better understand and improve their practice.

Until recently, information available to physicians regarding their performance was more about productivity than it was about the product. The delivered product – quality health care – was difficult to assess. There were few reliable measures and imperfect mechanisms to collect and report them. A hospital or a health plan might provide some data, though the reported measures were not always well explained or understood. Opportunities for action to improve were not often recognized or acted upon. And, there was no easy way for physicians to compare their performance to that of others. No wonder that physicians, while frequently active in quality improvement efforts in hospitals and other settings of care, were not often engaged in performance improvement activities focused on their own practices.

There has been significant progress in the last few years. Specialty societies are sponsoring registries that many physicians find useful in comparing outcomes for specific procedures.⁽²⁾ Specialties also have evolved programs for maintaining board certification that require performance improvement activity.(3) Even standards for continuing professional education are changing, placing increasing emphasis on active improvement activity, not simply attendance.(4)

Since 2007, Medicare has been contributing to this effort by collecting and reporting quality measures that inform on physician practice.(5) The measures used are developed and vetted by peers and tested for reliability and validity.(6) Quality measures today address a wide range of medical practice and are applicable to an expanding number of physicians.

More recently, Medicare has begun reporting measures of resource use.(7) Starting in 2015, these measures, in conjunction with quality measures, will be used in adjusting the Medicare Fee-for-Service (FFS) payment of physicians in large group practices for their performance.(8) By 2017, all physicians who participate in Medicare FFS will be affected by this value modifier.

The following is a list of suggestions and considerations that will help physicians understand the data being reported and use it to improve their practice:

1. Review your data. Consider the measures being used and their purpose and parameters, including inclusion and exclusion criteria. Learning cannot occur if the data is not reviewed and understood.
2. Look for variance. Does your data differ from that of your peers?
3. Identify opportunity. Where is there room for improvement?
4. Examine the process. Consider the goal of your care and determine the best way to achieve a successful outcome.
5. Select a change that is likely to help. For improvement to occur, something must change.
6. Implement the change. Once the change has been selected, it takes conscious effort to avoid reverting back to old habits.
7. Track progress. You don’t have to wait for another report. It can be useful to maintain your own progress sheet on your improvement project.
8. Refine the change. If your change is not working, don’t be afraid to modify it.
9. Celebrate success. Continue to monitor for slippage.
10. Repeat the improvement process as needed.

Understand that while not all variance will be within the physician’s direct control, it is likely to be within the physician’s sphere of influence. It is important to work with colleagues to understand variance and collaborate in following the steps above. Sharing what you are learning with peers will promote a culture of improvement.

Today’s data-driven health care environment provides opportunity for improving health care in ways not previously possible. Physician leadership in health care improvement is a necessary ingredient in the recipe for an effective, safe and efficient health care system.

References:
1 http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/physician-compare-initiative/
2 Berwick D, Jain S, Porter M. Clinical registries: The opportunity for the nation. http://healthaffairs.org/blog/2011/05/11/clinical-registries-the-opportunity-for-the-nation/
3 http://www.abms.org/maintenance_of_certification/
4 http://www.accme.org/node/19546
5 http://www.cms.gov/pqrs
6 http://www.cms.gov/qualitymeasures
7 http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/index.html
8 http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/ValueBasedPaymentModifier.html