Physicians are accustomed to poking and probing. They do it routinely as part of a better understanding of their patients’ health status. Of course, in those situations, it’s the doctor who does the probing.
74%—Percent of Americans who want better information to help them choose a doctor or hospital.(Healthmarkets.com, 2007)
Physicians are accustomed to poking and probing. They do it routinely as part of a better understanding of their patients’ health status. Of course, in those situations, it’s the doctor who does the probing. When the shoe is on the other foot, as it has been with increasing regularity in recent years during the effort to evaluate quality and cost of medical care, the poking that physicians have been experiencing can get quite uncomfortable.
One of the latest computer-based tools aimed at helping insurers, employers and government agencies make that quality and cost evaluation is the Physician Performance Assessment application developed by Thomson Healthcare. According to Thomson, the application evaluates whether medical care follows established clinical guidelines while accounting for the severity and duration of the medical condition being treated.
Jeff Hanson, Thomson Healthcare vice president, says the application’s methodology meets the needs of healthcare payors in a way that is also “credible, fair and helpful to doctors.”
Physician ConcernsHanson admits, however, “the angst is still out there in the physician community. We understand that.”
Physician “angst” stems from the potential manner in the way the assessment tool is used. David Schutt, MD, associate medical director for Thomson Healthcare, explains that the tool is designed to provide measurement in four different categories: descriptive information about the physician’s practice, such as demographics; quality information about the care the physician is providing; financial information; and information on utilization of services. Physician concern rises, says Dr. Schutt, when the tool only takes into account the latter two categories.
“Some health plans have networks in urban communities where there are lots of physicians, maybe even lots of hospitals, so plan enrollees have many choices as to which physician they want to see,” Dr. Schutt explains. “The health plan might use the tool to thin out a network; to say, ‘If you’re not performing the way we think you should perform based on our standards, then we’re going to invite you to leave the network.’ That implies an impact on the physician’s livelihood. So that usage makes physicians very nervous, unhappy, and downright angry in some instances.”
Dr. Schutt, a George Washington University School of Medicine graduate, says that Thomson advises its health plan customers to have their network physicians involved in the development, understanding and dissemination of the assessment tool. As part of the process, physicians can provide good insight into the use of the tool, its measures, and peer groups against whom physicians should be measured. Physicians, Dr. Schutt points out, don’t mind financial measures, as long as they’re being measured together with quality and outcomes.
“If you tell physicians that their peers are getting good outcomes and providing higher quality using fewer resources for the same kind of patients, then they’ll listen,” Dr. Schutt explains. “But if you tell them that they’re using too many resources but can’t quantify if their outcomes are better, worse or even the same, then they’re going to stop listening.”
Assessment BenefitsHanson explains that when used properly, the assessment tool can have a positive impact on physicians’ financial bottom line. He points out that payors employ a wide range of reimbursement tactics—from a flat fee schedule to year-end incentives for meeting certain practice guidelines. The Physician Performance Assessment tool can be used by physicians to maximize their reimbursement.
“It’s a tool that physicians can use to show that they’re meeting all the best in class measures of care,” Hanson explains. “That can help them in the financial negotiations that take place between payors and providers.”
The tool also does summary reporting, informing physicians how they performed during the current year as opposed to the previous one. It provides a trend, and if they’re trending in the right direction, physicians can use it to their financial advantage. "I can’t help but think [trending information is] a valuable piece of information for a reinsurer or a malpractice insurance organization to take into account in terms of setting a physician’s rates,” Hanson says.
Dr. Schutt, a board-certified family physician, reiterates that in this age of increased transparency in healthcare, the most effective and efficient way to use the performance assessment tool is to gain physician buy-in up front.
“The secrecy part, in the long run, never gets you anywhere,” Dr. Schutt explains. “In the short run, it may feel efficient and that you’re getting the job done faster, but this really is a group process. It takes time, but it’s time well spent on the front end. Because if you don’t do it on the front end, you’re going to do it on the back end. So, you might as well do it right the first time.”
Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at email@example.com.
“It is no use saying, 'We are doing our best.' You have got to succeed in doing what is necessary.”—Winston Churchill