Let’s start this blog series off by talking about what I believe is a fundamental requirement for a successful clinical quality improvement (CQI) program: Ambulatory clinical quality improvement programs need to be driven by physicians and their staff members if maximum improvements are to be seen.
Now, I realize that there are many companies out there hired by payers and employers to improve outcomes and cut healthcare costs, and they must be doing something of value. But I think most of you will agree that patients want their own physicians to manage and coordinate their care, not some stranger at a company they have never heard of. That’s certainly been my experience over the last 12 or 13 years, and I haven’t seen much benefit to my patients when outsiders are involved.
In fact, lately we’re hearing more and more from our payer partners that they are seeing suboptimal results from the CQI programs they administer. We are also hearing that these same insurers are putting more emphasis on engaging the physician and his or her office staff in the CQI process. Pay for Performance (P4P), Patient Centered Medical Home (PCMH), Medicare’s Physician Quality Reporting System (PQRS), Meaningful Use, Accountable Care, etc. are all payer-sponsored programs intended to financially reward physicians for providing higher quality care.
“So, what? What’s in it for me?”
I hear this from physicians a lot. We’ll discuss overcoming barriers to engagement in another post, but let’s look at a few of the benefits of higher quality care from the physician’s perspective:
- Higher quality care. Great! But maybe not enough to transform the way you practice. Let’s face it. The fee-for-service model doesn’t really encourage a transformation to a population-based care model.
- Professional standing and public perception. Huh? You’re a fantastic physician, right? You always do the right thing, and your patients love you. So, why are you not in the top 10% of physicians in your area but the physician in the suite next door is? More and more payers publicly report outcomes, like the new Physician Compare Website sponsored by CMS. You want to be at the top of every one of these lists to attract and retain patients.
- Decreased workload. Sorry? That’s like something for nothing. How can I see improvements in quality without adding work to my already hectic day? Automation and staff empowerment is part of the answer. Use technology to identify patients with gaps in their care, and then use that technology to automatically reach out to those patients to fill those gaps. Empower your staff members to tackle these gaps at every patient encounter (even med refill calls). Soon, care gaps will be filled, and you will have less to think about and less to do at each patient visit.
- Higher reimbursement. Now we’re talking. Physicians are finding that more and more of their income is dependent on providing and documenting high-quality care. The programs listed above all reward physicians in one way or another for focusing their energies and resources on improving clinical outcomes. Payment reform is just getting started, and the physicians who provide the most VALUE will be the winners. More on value in a future post.
As you can see, the perks of more quality-focused care are numerous for the physician, but that doesn’t answer the question of how you get there. This is something we’ll tackle in the next post, where I’ll outline specific goals you should reach in order to reap the benefits I’ve discussed here.
