As hospitals and health systems face the demands of the value-based care model and changing health care policy, physician engagement has become a crucial component to achieving their goals of quality improvement, decreased costs and greater patient satisfaction. The rules of engagement for hospitals and physicians are gradually shifting away from traditional paradigms towards a more collaborative approach that enables them to align best practices and share the common goal of the highest quality of patient care at the lowest possible cost.
One area where many hospital executives are finding the greatest need and opportunity to foster physician engagement and collaboration is in the reduction of clinical variation — the overuse, underuse, and different or otherwise unnecessary use of health care practices and services with varying outcomes. By engaging physicians and medical staff, hospital leadership can effectively communicate and achieve their expectations, goals, measures and accountability for clinical variation reduction efforts.
While every hospital and health system may be in a different place on their journey to transitioning from fee-for-service to value-based reimbursement, they should consider the next steps that are most appropriate for engaging doctors to reach their mutual needs and goals, for both the short- and long-term health of patients and the organization.
Physician-to-physician communications
One critical step hospitals must take to foster successful physician engagement is to establish processes that encourage physician-directed communications and physicians' meaningful involvement in identifying, measuring and reducing clinical variation.
These processes should empower medical staff leadership to establish and communicate new goals and a new vision that enables physicians to better understand how the shift to value affects their practice in the clinical setting. This should also entail the creation of interdisciplinary teams for high-volume diagnosic-related groups or service lines to review data and understand current practice variation.
As new value-based programs all require refined and expanded measures of quality and cost, these processes provide an opportunity to involve physicians in capturing and reporting new metrics as well as identifying opportunities to improve care processes and outcomes. Physicians should be encouraged to actively participate in analyzing and interpreting data to identify what variation exists, where there has been an inappropriate use of resources and where there are opportunities to reduce variation. These initiatives can be led and determined by physicians by encouraging their involvement at every stage of the analysis.
Advanced tools for data analysis
The physician leadership within the organization, whether it is the chief medical officer, president of medical staff or department chairs, should implement the use of risk-adjusted analytics to measure clinical outcomes, and encourage physicians to actively participate in measurement initiatives to track quality and cost outcomes. Analytics-based tools can help enlighten doctors on variation in resource use in areas such as diagnostics, pharmaceuticals and others.
For example, a physician-led team could review risk-adjusted data showing average orders per patient and average direct cost per case by physician. Focusing on a diagnostic cohort such as total joints or coronary artery bypass grafting allows physicians to see variation between their cases. Providing further detail of physician-level order variation allows for detailed comparison across cases, along with order sets and evidence-based medicine. Physicians have the detailed input they need to adjust practice patterns and reduce variation.
Accurate risk-adjusted data are a foundation for engaging physicians, giving them insights into their variation in resource usage. Risk-adjusted data are derived from a statistical process that takes into account the underlying health status and resource utilization for the patient when looking at health care outcomes and costs.
For example, the All Patient Refined DRG methodology categorizes each patient into one of four levels of severity, with one being the least severe, based on a number of patient differences related to principal and secondary diagnoses, procedures, age and sex. It allows clinical teams to understand the severity of illness of each practitioner’s patient population, thus eliminating any concern that one set of patients is more complex than another.
Physicians are scientists and require data first in order to review and understand differences in resources and outcomes. Trustworthy risk-adjusted data enable them to compare “apples to apples,” not “apples to oranges,” because it has been acuity-adjusted. Physicians will more actively engage in an analysis of best practices and outcomes and where to reduce clinical variation if it is based upon strong data. It can reduce resistance to change and encourage their buy-in to the analysis and reduction of clinical variation.
Ongoing reporting and evaluation
To ensure the sustainability and support of best practices, it’s also important that clinicians and the entire health care team have access to updated analytics on a frequent and regular basis. Ideally, updated data should be provided on a monthly or quarterly basis, depending on the metric, so that improvement teams can evaluate the effect of initiatives and continue to adjust improvements in a timely manner.
Scorecards encourage medical staff and hospital leadership to measure their progress towards defined goals, to monitor trends, and to identify new opportunities for improvement. To demonstrate progress, it’s helpful to provide both blinded and unblinded physician scorecards that gauge improvement in targeted metrics. Dashboards can be used to provide an overview of program effectiveness and its relevance to the various disciplines on the team, as well as clinical, quality and financial considerations.
By embracing a collaborative approach to physician engagement initiatives, hospitals can make significant progress toward reducing clinical variation while enhancing physician-hospital relations. In doing so, they can dramatically improve the value of care delivered to the patient, and position themselves and their physicians for stronger financial and operational performance in today’s competitive health care environment.
Nancy Lakier is CEO and John Malone is vice president of Novia Strategies in Poway, Calif.
The opinions expressed by the authors do not necessarily reflect the policy of the American Hospital Association.
