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How do we measure up?

The new world of data and quality reporting, and the importance of Peer Review

As practicing physicians we think we provide good quality care to our patients. But how do we know that, and how do we prove that to the world of insurers, employers, payors and patients who increasingly question our actions and outcomes, and increasing costs.

Beginning this year Medicare's hospital reimbursement is adjusted by an outcome measure called Value Based Purchasing, part of which consists of conventional outcome measures and part is based on patient satisfaction. Although we may have concern about the legitimacy and accuracy of these measures, realize they are not up for negotiation, and more such measurement is the way of the future. The mantra of business is "You can't manage what you can't measure."

But many of the currently available measures are terribly inaccurate and unscientific. I found a "grade" of myself online, based on 5 patient encounters over a period of 3 years. During that interval I had just under 9000 patient encounters.

Although I find it hard to believe my interaction with a patient in the office discussing nonsurgical options for relief of their neck or back pain, or my performance in the OR removing a brain tumor, can be easily or accurately measured and scored, there are parts of our care that can be quantitatively assessed, and hopefully improved upon. This is our opportunity for peer review -- the assessment of physician performance by physicians.

As most of you know, for many decades the Joint Commission was the only means of a hospital proving to payors, especially Medicare, that standards existed and were followed in the provision of hospital care. However, as any of you who were involved in the detail of preparing for a Joint Commission visit can attest to, the process involved lots of polish and paperwork and seemed to have little to do with improving patient care. It was not surprising when the Joint Commission lost their "deemed status" from Medicare. At that point Kaleida Health and its Medical Staff Leadership selected DNV, a top notch international standards organization, as our means of demonstrating quality care and improving on that care.

Both DNV and the Joint Commission have required physician leadership to measure and improve physician performance. There is now a system wide physician led Peer Review Committee. The mission of this committee is to identify and implement means of improving patient care. The goal is not disciplining outliers but improving care across the board. A number of measures or indicators are being reviewed. Some are true outcome measures. Some are process measures. Medical staff members need to understand that each of these are being carefully selected by practicing physicians here at Kaleida Health, not an anonymous advisor to a proprietary guideline company on the West coast, who probably hasn't touched a patient in ten years.

As we roll these out over the next year, realize that this process will take time to mature. Reporting will generally be direct and confidential to each physician. Some reports, especially for outstanding results, may be generally and publicly shared, to acknowledge great work and to foster best practices. And some scores may be shared in groups of similar practitioners -- to acknowledge, to prod, and maybe even generate some friendly competition for best outcomes.

Providing and demonstrating great patient care is up to us. That is the essence of peer review.

Kevin J Gibbons, MD
Medical Staff President, on behalf of the Officers and The Peer Review Committee of Kaleida Health