Program Performance Measurement

Here’s Why This Is The Best Study On Readmissions To Date

  Love or hate readmission rates as an effective measure of institutional performance, the benchmark has become the coin of the realm for QI gurus, policy geeks, and stat crunchers.  As such, we see new journal releases every week--mostly data dives into large registries where the conclusions proffered are tentative at best.  Clinicians rarely get studies comprised of patient-level information whose findings may impact how to better organize their PI interventions and direct care.  That just changed (see excerpted table at bottom). Andrew Auerbach, MD MPH and colleagues just published, Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients in JAMA IM, and the results merit a deeper look.  Andy was kind enough to answer some questions regarding his group's important paper for the blog. Q:  Andy, first off, you and your collaborators should be congratulated on releasing the most exhaustive study on readmission root causes to date. For readers, can…

Hospital Hiring Is Not A Positive Prediction Rule

  When you follow the healthcare sector, you can depend on December being the time CMS and Health Affairs release cost growth estimates from the prior year.  All the papers give the news big time attention (see here). After looking at the charts annually, you inure to the trends.  It is like gas prices.  You just know when something breaks course, and you need to dig deeper.  2014 does not disappoint. My eyes always go right to the hospital sector: (more…)

You Can Learn A Lot From Billing Data.

Because hospitalists lack a specialty code for billing (probably forthcoming), and we do not have formal board certification (I would bet it's in our future), anyone interested in identifying hospitalists beyond their hospital walls has a tough slog.  You can call several thousand hospitals and speak with the appropriate department and question; you can call every internist, pediatrician or family practitioner in the AMA database and ask them, "Are you a hospitalist?"; or you can find an alternate method---because the latter two will keep you busy until the next solar eclipse. Knowing adult inpatient practitioners bill just a small cluster of codes--observation, critical care, or inpatient--having access to a national database with physician billing data (Part B submissions) would provide a route to determine which docs practice in acute care settings.   (more…)

Physician Assessment Gone Bad

  Some in our profession have begun to think hard about our future pay and incentives, especially given the vagueness of the recently passed MACRA legislation. MACRA replaced the SGR and put in place a model of compensation that in theory balances both physician accountability and just rewards for hard work.  The two MACRA tracks, the Merit-Based Incentive Payment System (MIPS) or the Alternative Payment Model (APM) are long on promise, however, but short on substance.  Read here for more (a brief and outstanding NEJM commentary). So much needs working out, and first among them requires us to deliver an appropriate means by which to assess physician achievement.  We have no functional framework to work off of and no history as a guide. How do you evaluate a provider when few valid instruments to measure performance exist? How do you reward a doctor for value when your metrics do not…

Improving the “Performance” of Performance Measures

By Greg Seymann, MD, SFHM As performance-based reimbursement strategies take center stage in healthcare payment system reform, the landscape for hospitalists remains stagnant, as we still lack a critical mass of relevant performance measures. Under the Physician Value Based Purchasing (VBP) program, all hospitalist groups of ten or more eligible providers are subject to a pay cut from Medicare if they are deemed high cost and/or low quality. In January 2016, this cut will apply to all hospitalists, regardless of group size. The intricacies of how providers are evaluated on cost and quality are fleshed out here, but the majority of the quality barometer is based on self-reported performance measures via the Physician Quality Reporting System (PQRS). Currently, there are only 15 measures in the realm of hospital medicine that are reportable using inpatient billing codes, but several of them are something of a stretch. Even though they have links…
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