Future of Health CareMedical EducationPerformance Improvement
December 19, 2018

There’s More to be Learned from Good Results than Bad—and Why It Matters

Becoming a physician requires passing many tests, beginning with premed studies, all the way through residency and, ultimately, board certification. You spend countless hours focused on passing examinations or rotations and learning to avoid pitfalls. As a residency program director, I and my colleagues invested considerable effort to determine which residents were struggling and to develop strategies to help them. We focused on finding deficiencies that would impede them from being excellent physicians. A fellow faculty member ran a Morbidity and Mortality conference that he nicknamed the “boo-boo” conference. This process of identifying and analyzing medical errors produced competitive physicians,…
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ACOsAdvanced Alternative Payment ModelsConsumers & PatientsMedical Decision-MakingValue-Based Health Care
April 11, 2018

ACOs Must Create Learning Environment for Physicians to Be Partners in Change

The idea behind ACOs sounds simple enough: Build a network of primary care physicians, specialists, hospitals and other health care organizations that share risk and responsibility to provide coordinated care for each patient. Medicare or private insurers offer financial incentives to ensure that ACOs provide quality treatment while limiting unnecessary spending. Primary care physicians serve as key liaisons for each patient’s care. But ACO reality is much more complex and daunting. Shared savings have proven to be elusive. Quality benchmarks do not always accurately measure what’s medically relevant. Patient attribution to specialists, rather than primary care physicians, skews costs. Nonetheless,…
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Consumers & PatientsFuture of Health CareMedical Decision-Making
February 14, 2018

Don’t Just Check the Box: Capture the Patient’s Story to Define Meaningful Goals of Care

What does Shared Decision-Making between doctor and patient really look like? I spent four decades as a primary care physician, as well as 27 years teaching medical students and residents. Looking back on my treatment of patients, I now question whether my management was driven by what the patient wanted—or by what I wanted for the patient. Certainly, I wanted to do what was in the best interest of the patient, and I sincerely hope that our interests were often well aligned. In certain specific cases, I acted against the stated desires of the patient, a necessary call (discussed below).…
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Future of Health CareMedical Decision-MakingPerformance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
January 17, 2018

Time Out! How Strategic Pauses Can Enhance Medical Decision-Making to Improve Outcomes 

Health care providers are under increasing pressure to improve outcomes for patients with chronic conditions. There is pressure to meet quality measures, to establish programs that improve outcomes, to decrease costs for these conditions (utilization as an outcome)—or a combination of goals. At issue: what works, what is affordable, what is acceptable to patients and clinicians. The answers are elusive because there are many factors involved in the care of patients who have numerous chronic conditions, co-morbidities and medications, as well as multiple healthcare professionals providing their care. Adding to this complexity, any outcomes improvement for patients with chronic conditions…
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Future of Health CareMedical Decision-MakingMedical EducationPatient EmpowermentPerformance ImprovementQualified Clinical Data Registry Reporting
April 26, 2017

Primary Care Physicians’ Ethical Dilemma: Meet Goals for Patients or Practice Owners?

Primary care physicians are on a collision course with health care consumers—their patients. While trying to deliver best clinical care, they must navigate a competitive business environment that encourages higher spending. The business of health care has undergone rapid consolidation in physician practice ownership. Spurred by the need to compete for patients, use EMR technology and manage within the heavily regulated health care industry, physicians have moved from smaller to larger group practices. Primary care physicians have made this transition faster than specialists by selling their practices, and are now more likely to be employed by a hospital. But this…
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Future of Health CareMedical Decision-MakingPerformance ImprovementRegistry ScienceResearchValue-Based Health Care
October 11, 2016

Physician Culture Must Transition from Defensiveness to Performance Improvement

Physicians undergo long and arduous training, with good reason. Lives are at stake. Learning to make the correct diagnosis, to expertly perform the appropriate procedure and to properly treat conditions is essential. Mistakes or flaws are scrutinized and not tolerated. Being wrong may cause greater harm to the patient—and lead to malpractice litigation. In short, physician culture places a premium on individual performance and responsibility. Steeped in those values, most physicians take great pride in the quality of care they deliver to patients, in the examination room or the surgical suite. Teams who provide specialized services, such as Emergency Departments,…
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Clinical Data RegistryMACRAMedical Decision-MakingMerit-Based Incentive Payment System (MIPS)Performance ImprovementQualified Clinical Data Registry ReportingRegistry ScienceResearch
July 19, 2016

MACRA Match-up: How EHR Source Data Will Benefit Registry Research

At the core of MACRA and MIPS requirements, Electronic Health Record (EHR) source data will soon become a key component for Registry research. Specifically, Clinical Performance Improvement Activities (CPIAs) are a required component of MIPS. Performance improvement efforts will no longer be optional. Quality data will be essential. EHRs present an excellent data resource, but the data is not flawless. Registries are well suited for validating data and assessing performance using a continuous improvement model—testing an idea by changing a practice and measuring its impact. When done on a small scale, testing performance improvement activities and the feasibility of population-based…
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Alternative Payment Models (APM)Future of Health CarePerformance ImprovementSpecialized RegistryValue-Based Health Care
April 12, 2016

Boutique Medicine’s Quality Challenge: Can Specialized Registries Aid Consumer Choice?

Many physicians—especially those in primary care—are angry about the practice of medicine. Dogged by high administrative overhead, they feel the pressure of shorter visit times to meet the practice’s income needs. In some geographic areas, PCPs are opting out of Medicare assignment in large numbers and establishing boutique medicine practices (including “concierge medicine”). Indeed, as CMS pushes providers toward risk under Alternative Payment Mechanisms (APMs) and away from the traditional fee-for-service, concierge medicine has become an attractive alternative for physicians who are fed up with the system. What does this trend mean for access and quality of care, especially when…
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryFuture of Health CareMeaningful UseMerit-Based Incentive Payment System (MIPS)Performance ImprovementRegistry ScienceResearchValue-Based Health Care
February 2, 2016

All Together, Now: Why Specialists Need the CDR Edge for Bundled Payments

With the advent of Bundled Payments for selected procedures and conditions, providers and institutions must collaborate to meet both cost and quality targets. No longer will each provider bill and receive payment separately for services when these bundles become mandatory—as most experts believe will happen. All providers participating in a set “bundled” price must focus on coordinated performance improvement or face penalties. Key to that effort: a Clinical Data Registry (CDR) that tracks patient outcome data over time and pinpoints success or failure of interventions. CDR Performance Improvement Tools Are Essential for Bundled Payments Success The CDR fulfills two fundamental…
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AttributionClinical Data RegistryFuture of Health CareMeaningful UsePerformance ImprovementValue-Based Health Care
January 12, 2016

Public Health Reporting for Specialists: Avoiding Penalties Isn’t the Only Reason to Comply

At the heart of CMS’s Public Health Reporting Requirements for Meaningful Use is a basic premise: EMR technology must facilitate tracking of public health trends and long-term outcomes improvement. That is why all providers in the Meaningful Use program, regardless of specialty, are now being required to engage in public health reporting to avoid a penalty. Many specialists don’t see the point of reporting for public health reasons or find it too difficult. While it’s true that specialists face some specific challenges that require dedicated reporting to fit their clinical operations and to avoid professional and financial risks, there are…
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