Stay Tuned for More Talk About Physician Quality Ratings

Friday, May 19th, 2006
This post was written by Melanie Matthews

Sometimes art imitates life, and sometimes television hospitals resemble real ones. This season, a hospitalized Tony Soprano was assigned a health plan champion who scrubbed his care plan of unnecessary and costly procedures while “T” worried about his missing insurance card. And this week, between the dream rantings of Scrub’s central character Dr. John “J.D.” Dorian, doctors at the mythical Sacred Heart Hospital debated physician quality ratings. J.D. overhears his gruff mentor Dr. Cox berate a female surgeon over her decision not to operate on an elderly patient. Dr. Cox accuses her of rejecting the patient because his less-than-optimal chances of recovery might torpedo her professional quality ratings. “You got me,” she admits.

When Turk (J.D.’s amiable surgeon sidekick) admits that quality standings are a common concern among surgeons, J.D. overlooks his colleague’s decision and pursues a relationship with her. At this quirky television hospital where most but not all endings are happy ones, the surgeon ultimately decides to operate on the elderly patient, quality ratings be damned.

All this to say that if make-believe hospitals are caring about healthcare costs and quality issues, you can bet that real-life ones are, too. Health plans, employers, consumers and even the federal government are leaning on providers to document quality initiatives. The U.S. Department of Health and Human Services’ (HHS) Hospital Quality Initiative already links reporting of 10 quality measures to the payments these hospitals receive for each discharge. An HHS division, the Centers for Medicare and Medicaid Services (CMS) also recently launched the Physician Voluntary Reporting Program. While physician reporting is voluntary for now, this initiative provides a peek into the future of pay-for-performance (P4P) programs for physician practices.

In CMS Physician Voluntary Reporting Program: Weighing the Benefits of Participation, we take a look at the CMS request for doctors to voluntarily self-report adherence to certain evidence-based quality measures beginning in January 2006. The initial set of standards aims to hit as many specialties as possible. While the IT requirements of reporting this data can be challenging, the benefits of getting in on the voluntary reporting effort are many. Julie Baker, director of healthcare advisory practice at PricewaterhouseCoopers, says participating now when confidentially is assured, results unpublished and feedback readily provided “allows physicians to prepare for P4P in a safe environment” and prepares them for the eventuality of mandatory reporting. We think this is the way to go, too.

Like the curmudgeonly Dr. Cox, critics of healthcare report cards fear their dominance will drive physicians to select only those patients likely to have the healthiest impact on their quality standings. However, we’re more optimistic. Consumers are a savvy bunch. Just as they gave a thumbs-down to pudding in a tube, smokeless cigarettes and aerosol toothpaste, consumers will eventually smoke out healthcare providers operating in this manner. These physicians will have to build their practices equitably and honestly or risk getting an “F” in customer service on their report card.

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