Newtown, CT – January 15, 2016
There are several ways to make quality measures more patient-centric. One is to design them that way, the other is to collect them that way – As mentioned last week, we must resolve to make quality measurement far more patient-centric than it is today. Most quality measures are designed to measure discrete processes or outcomes tightly linked to the actions of a clinician or facility for the treatment of a specific condition, injury or illness. That may be marginally good if a consumer-patient only has one medical event going on, but it fails miserably where it matters most, which is when patients have several things going on. And it fails not simply to provide information on how well the patient is treated overall, it also fails the clinicians being measured by providing them a very partial view of their patients instead of a comprehensive one. This, by the way, isn’t by accident, it’s by design. Measures are submitted by medical specialty societies, on behalf of their members, and then follow some circuitous political route to general acceptance. The collection and publication of these measures, when allowed, are also done clinician by clinician, or facility by facility, considering each an island unto itself. Oftentimes, that measurement is done payer by payer, providing a further artificial segmentation of performance, and one that can be conflicting, with some payers reporting good performance while others report the opposite. There are better ways of doing all of this.
What this means to you – How can we expect physicians and facilities to improve the quality of care they deliver to patients if they don’t even have a complete view of their performance, or of what happens to the patient? For 15 years we, at HCI3, have been working with physicians to design comprehensive, reliable, and timely feedback loops on their quality of care. What we have found is that these feedback loops are the essential source of motivation for care reengineering, the battery that charges the clinicians every day by giving them the intrinsic jolt to improve the quality of care they deliver. And it’s not difficult to understand why. Clinicians are trained scientists and all scientists crave feedback loops that help them continuously calibrate their interventions to deliver more desirable outcomes. Today, the feedback mechanisms are distant – coming from some third party payer on a portion of patients; untimely – they most often lag performance by months, if not a year or more; and unreliable – they suffer from sample size errors and data with distorted signals. But when clinicians create feedback loops that are tied to internal and external medical record data, collected daily and reported at least quarterly, the impact is radically different. And the irony is that it’s just not that difficult to get it done. After all, we’ve been doing it for more than a decade on a shoestring budget, and in a recent report supported by funding from the Robert Wood Johnson Foundation, we explain how states can and should organize these feedback loops as an integral part of their delivery system transformation efforts. And there are two other essential feedback loops needed to complete the patient-centered view. One on the patient’s experience with their care and the progress they are making as individuals. The other is on the affordability of the patient’s care, including the lack of costs associated to avoidable complications. All of this can be done today by those who, like us, resolve to getting things done right.
Francois de Brantes