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