Physician report cards make the honor roll

By Erin McCann
11:18 AM
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Hospitals boost national rankings, see savings soar

WASHINGTON – Life is one constant assessment. Analyzing one’s performance in a given category, these assessments can offer quantifiable feedback as to what one can improve upon. A “C” in math? Hold the video games; take the tutor. Four divorces? Perhaps it really is “it’s not you; it’s me.”

These assessments are now percolating into the realm of healthcare. With pressure to trim costs and improve patient care, hospitals have long turned to information technology to help them address physician performance.

Crimson Continuum of Care, an Internet platform developed by The Advisory Board Company, offers healthcare facilities a comprehensive assessment for physicians by collecting data from a variety of different systems, then aggregating it into a single report.

Two hospitals in New Jersey and Nebraska share their stories on how the Crimson platform helped them improve dialogue with physicians, reduce patient readmissions, increase national rankings while altogether eyeing the mounting savings.

After implementing Continuum of Care, Alegent Health, a 10-hospital health system in Nebraska, has seen a whopping $2 million in annual savings and improved or maintained nearly 100 percent of its quality metrics.
Rick Miller, MD, chief quality officer, Alegent Health, said “Crimson allows you to dig down into what a doctor, for an individual patient, ordered on a day-by-day basis,” which in turn helps you address issues such as over-ordering or under-utilizations.

He cited physician-ordered chest X-rays for pneumonia patients as an example.

“People with pneumonia aren’t in the hospital for many days, but we had a range of chest X-rays from one to five.” The problem with this, Miller explained, is that one’s chest X-ray typically “changes over a week or two, so getting a second chest X-ray in the hospital doesn’t tell you anything more than the first one did. So unless the patient’s condition changes dramatically, you need one.”

After Miller shared this data with the physicians and explained the science behind it, he saw the number of chest X-rays drop dramatically.

Thomas Heleotis, MD, VP of clinical effectiveness at Monmouth Medical Center in New Jersey turned to Continuum of Care because he had been looking for a report card that would give a comprehensive assessment of physicians without just focusing on the financial aspects. “In order to have a meaningful discussion with a physician about his impact on the hospital, you can’t just talk about the finances.”

For Heleotis, the finance talk proved significantly more on point when the subject of annual savings arose. After going live with the platform technology in 2008, Monmouth Medical Center has seen savings of more than $10 million.

Reduced spending also met with higher national rankings, as Monmouth ranked in the top 10 percent of U.S. hospitals for 96 percent of the metrics in 2011 compared with only 67 percent in 2007.

The hospital has cut readmissions from 23 percent down to 12 percent and has also decreased the length of stays.

When it came time to implement Continuum of Care, Heleotis witnessed a more engaged discussion with the physicians. The platform offered a more holistic assessment, bringing in areas of physician performance such as complication rates, mortality rates, ordering habits or 30-day readmissions.

“So you could ultimately say to the physician, ‘look, you’ve done really well on your core measures or on your patient safety indicators, and your readmission rate is great and your mortality is great and your complication rates are good, but when it comes to using resources, you’re a little heavy here, a little heavy there,’” Heleotis said. “It was a more congenial discussion rather than focusing right in on their finances.”

Physicians can also compare their metrics with others across the country.

In order for the platform to be effective, however, you can’t rely solely on the technology, as Paul Roscoe, CEO, Crimson pointed out. For successful implementation and positive outcomes, strong physician leadership is essential.

The approach, Roscoe continued, must also be taken into consideration. What you don’t want to do is “present a bunch of data to the physician and say, ‘hey you’ve got to do better than this.’” Rather than reprimanding or critiquing, it should be about “engaging [the physicians] and then actually having them participate rather than presenting them as a scorecard or a dashboard.”

Heleotis concluded, “It’s critical for physicians to know how they’re impacting the delivery of healthcare, particularly in the inpatient setting. Besides meeting with the physicians and showing them their data and watching their length-of-stay drop, watching their quality metrics go up, watching their costs-per-case go down every quarter by a hundred dollars, two hundred dollars, you can see the gradual improvement that’s occurring. And it’s nothing more than making them aware of what they’re being held responsible for.”