Dealing With Uncertainty in Practice Measurement

Posted on September 30, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Variations in Medical Care Quality

By Brent A. Metfessel MD, CMP™

www.BusinessofMedicalPractice.com

Due to high-profile concerns in terms of the variation in quality of care as well as its affordability, practice pattern measurement is here to stay.  And, until further advances in this area are created, physicians with unexpectedly poor performance ratios, especially in the area of cost-efficiency, should review their data to determine if there are opportunities to improve as well as potential outlier cases contributing to an aberrant value, as well as looking at the health plan methodology for statistical analysis and outlier exclusions. 

Communication is Key

It is important for the physician or other provider being measured to communicate any issues to health plan personnel where possible. Physicians need to remember that practice pattern analysis is a continually evolving field. 

Assessment

Given the state of the art, physicians, specialty societies, and other advocacy groups have a responsibility to work with health plans or other practice measurement agencies to make sure quality improvement is at the forefront, that they are active in giving feedback on health plan practice measurement methods, and that as much as possible a collaborative approach is used in working with health plans and other measurement organizations.

Conclusion

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Understanding Disease Management

Posted on September 27, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

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How Technology Affects Patient Care

By Brent A. Metfessel MD, CMP™ [Hon]

www.BusinessofMedicalPractice.com

One area where technology assessments, clinical guidelines, and EMR data can make a true difference in patient care is in disease management.

DMAA Definition

The Disease Management Association of America (DMAA) defines disease management as “a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant”.  Disease management supports the physician-patient relationship and places particular significance on the prevention of exacerbations and complications of chronic diseases using evidence-based clinical guidelines and integrating those recommendations into initiatives to empower patients to be active partners with their physicians in managing their conditions.

Usual Conditions

Typically, targets for disease management efforts include chronic conditions such as asthma, diabetes, chronic obstructive pulmonary disease, coronary artery disease, and heart failure, where patients can be active in self-care and where appropriate lifestyle changes can have a significant favorable impact on illness progression.

Outcomes Measurement

The DMAA also emphasizes the importance of process and outcomes measurement and evaluation, along with using the data to influence management of the medical condition.

Assessment

Although claims and administrative data can be used to measure and evaluate selected processes and outcomes, EMRs will be needed to capture the full spectrum of data for analyzing illness response to disease management programs and to support necessary changes in care plans to improve both intermediate outcomes (such as lab values), and long-range goals (such as the prevention of illness exacerbations, managing co-morbidities, and halting the progression of complications).

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Conclusion

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Why Hospital IT is Almost like a Retail Mall

Posted on June 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Hospital Bar-Coding Systems

By Brent A. Metfessel; MD, MIS

www.HealthcareFinancials.com

Given anticipated benefits in patient safety, the FDA required in April 2006, that bar codes be installed on all medications used in hospitals and dispensed based on a physician’s order.  The bar code must contain at least the National Drug Code (NDC) number, which specifically identifies the drug. 

Unfortunately, by 2008 only about 18% of hospitals used bedside bar coding systems. Nevertheless, this ruling heightened the priority of implementing hospital-wide systems for patient/drug matching using bar codes and implementation that is still growing rapidly today.

Procedures

Conceptually, the procedure for bar coding is as follows:

  • The drug is given to the nurse or other provider for administration to the patient.
  • Once in the patient’s room, the provider scans the bar code on the patient’s identification badge, which positively identifies the patient.
  • The medication container is then passed through the scanner, which then identifies the drug.
  • The computer matches the patient to the drug order.  If there is not a match, including drug, dosage, and time of administration, an alert is displayed in real-time, enabling correction of the error prior to drug administration.

Enter the FDA

The FDA estimates that over 500,000 fewer adverse events will occur over the next 20 years, a result of an expected 50% decrease in drug dispensing and administration errors. The decrease in pain, suffering, and lengths of stay from drug errors is estimated to result in $93 billion in savings over the next 20 years. 

Avoidance of litigation, decreased malpractice premiums, reduction in inventory carrying costs, and increase in revenue from more accurate billing result from the improvement in quality and efficiency of care.

This makes implementation of bar coding technology relatively low-risk, although there needs to be sufficient informatics capability to capture and store drug orders.

Estimated Cost Savings

For a bar coding system, a 300-bed hospital may expect up-front costs of $700,000 to $1.5 million with about $150,000 in maintenance fees annually.  The returns, however, in terms of improved patient safety and cost of care make an investment in bar coding technology one of the more cost-effective information systems investments.

Assessment

Also, given the increasing consumerism in healthcare, prospective patients will be more assured of care quality from a hospital investing in state-of-the-art technology in this area, giving the medical center a competitive advantage.

Conclusion

Thus, hospitals are becoming more like retail businesses every day … finally!

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On Physician Bonuses

Posted on October 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Money and Incentive Pools 

By Brent A. Metfessel; MD, MSbiz-book

Some Managed Care Organizations [MCOs] use medical provider profiles to allocate funds to the top-performing physicians. The MCO may give additional bonuses or preferential allocation of incentive pool funds to providers that perform well on particular cost-effectiveness and quality indices. 

Incentive Pools

Incentive pools are often built based on a certain percentage or “withhold” of dollars that are taken from the providers’ usual reimbursement and placed in a pool.  Top performers would be allocated the greatest percentage.

Example:

One mid-sized health plan in the Southeast paid a 20% bonus to providers with a case-mix adjusted performance ratio (actual/expected cost) of less than 1.3. Although such allocation schemes might incent providers to practice efficiently and with high quality, the MCO should attempt provider education as to the most appropriate practice patterns for the first one to two years after new profiles are introduced. This education should occur prior to introducing monetary incentives, since otherwise the relationship between providers and MCOs may ultimately become strained. 

Assessment

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Unfortunately, money can become a major point of contention between providers and between providers and the health plan.

Conclusion

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Goals of Medical Performance Improvement

Posted on October 18, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Best Clinical Practices

By Brent A. Metfessel; MD, MSbiz-book

The major goals of medical performance improvement are twofold: First, for a particular practice pattern measure, the desire is to narrow the practice variation around the present health care mean. For instance, the spread of the distribution of a cost variance measure should decrease with process improvement.  Second, clinical guideline-based “best practices” can be utilized to move the entire provider population mean toward better cost-efficiency and quality.

Best-Practices

Although best-practices may be guideline-based, they should be adapted to local considerations and evaluated periodically through actual outcomes analysis. Such outcomes measures may include:

  • Cost-efficiency improvement, showing a decrease in resource utilization.
  • An increase in the performance of preventive measures, such as childhood immunizations and various screening tests such as breast and cervical cancer screening.  This may increase costs initially but will more than pay for itself through a decreased illness burden and cost in the future.
  • A decrease in episode length, usually implying a quicker resolution of symptoms.
  • A decrease in emergency room visits and unplanned hospital admissions.
  • A decrease in the rate of “sentinel events” such as status asthmaticus, hemorrhage during pregnancy, diabetic ketoacidosis, and ruptured appendix.

Many of these measures can be obtained using commonly available claims and administrative databases, although supplementation with clinical and functional status data will only increase the reliability and scope of outcomes analysis.

Assessment

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In order to see significant performance improvement in response to quality improvement initiatives, one must be patient.  Two to three years may be needed to see this improvement.  Trending of measures helps analysts to determine whether such improvement is occurring.  Trending of data, however, can be quite resource-intensive since there must be an adequate data set – usually requiring storage of data for several years of experience. 

Conclusion

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Filed under: "Doctors Only", Career Development, Health Insurance, Managed Care, Practice Management, Quality Initiatives, Recommended Books | Tagged: , , , , , | 2 Comments »