physician performance and reporting commentary david w. bates, md, msc medical director of clinical...
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Physician Performance and
Reporting Commentary
David W. Bates, MD, MScMedical Director of Clinical and Quality
Analysis, Partners HealthcareChief, Division of General Medicine,
Brigham and Women’s Hospital
PQRI—One Perspective Think this will be a key lever (probably the
key lever) for encouraging adoption Unclear whether level of incentive will be
sufficient to have desired impact Will generate hot debate in physician
community Have to try and see Should begin to engage consumers
Pay-for-Performance Key Components Individual vs. group incentives Paying the right amount Selecting high-impact performance
measures Making payment reward all high-quality
care Prioritizing quality improvement for
underserved populations
Rosenthal and Dudley, JAMA 2006
Reports
Quality Dashboard
Ad hocqueries
Disease Registries
LMR Quality Data Warehouse
LMR
PatientsProvidersClinicsVital signs, weightsSelected lab valuesAllergiesVital status
LMRQualityDWH
Other sources
ProblemsMedsNotesHealth MaintenanceFlow Sheets
PopulationMgmt
Externalize information from Partners ambulatory electronic health record
Make that information available in a variety of ways
Massachusetts eHealth Collaborative Got $50 million from Blue Cross Identified 3 communities in Massachusetts
Gave them EHRs Made vendors agree to represent data in standard
ways Allow extraction of quality data
Setting up clinical data exchange Setting up a data warehouse for quality
data All 3 communities will have a central store
Still hasn’t been easy—EHRs don’t include the necessary tools off-the-shelf
Why EHRs are Better than Claims MUCH more detailed data
Blood pressure Full laboratories
Can record things like bilateral mastectomy, or patient with another inoperable cancer Also refusals Provider buy-in better
Covers ALL patients
Key Pitfalls for Program Could easily be set up in ways that would
not make extraction easy or even possible Having accurate links between patients
and providers Most commercial EHRs don’t currently
facilitate either improvement or reporting Need to try to avoid appearance of
unfunded mandate (has to look like a carrot)
Key Points to Emphasize Providers need registry function, and
reminders from EHRs Eventually tools to enable team functions
Making reports available to providers Allowing drilldown
Quality measures will be carefully scrutinized by physician community
Extraction has to be easy Pull is best if feasible
Regulatory Keys At start should be easy to qualify
Gradually raise bar Will need to follow whether amount has
desired impact Physicians need to be able to see how
they are doing
Conclusions If pay sufficient attention to the 5 key
elements should be possible to be successful Paying right amount, selecting right measures,
and using incremental payment are important Using EHR data is much more accurate
than claims and should be using that There are many good EHRs on market and
need to provide market incentives to use
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