Physician leadership in the New World- Part 3- Excelling in the Pay-for-Performance Process

In my last two blogs I discussed two important tasks of the physician leader:   learning  how to enhance personal  management skills and how to better transition from a lone provider to an invaluable member of the health care team.  In this section I will discuss one of the most important and unique roles of the physician executive:  Championing the culture of quality and patient safety.

From my perspective, advocating quality and safety cuts to the very essence of being a physician; they both come right from the Hippocratic oath.  Every physician should hold these values very high.  Although all members of the health care team should share in owning quality and safety, high quality and safety are truly inherent and fundamental to the role of the successful physician executive.

Delivering on quality and safety is no small task.  In fact, quality improvement is a lifelong cycle; it is never finished.  Coupling that challenge with cost-effectiveness makes it even more difficult.  Operationally from the perspective of the physician executive, there are three fundamental components to best achieve the highest level of quality and safety:

1. Embracing data transparency as a way to do business

2. Implementing evidence-based practices in all service lines

3. Excelling in the pay-for-performance process

In the last few years, data transparency has become one of the most powerful influences in healthcare.  On the quality and patient experience side, transparency has done more to improve performance than any other intervention I can think of.  In my presentations I state that “transparency is the best thing that has happened to quality since antibiotics”.  The physician leader must embrace this concept as a the fundamental way to improve the performance of the entire health care team.

In the next few years we will see a greater consumer demand for transparency of price.  This will be a huge challenge for the health care field as the very things that transparency did to improve quality, raising the bar and decreasing the variance, may very well have the opposite effect on price…. by lowering the bar and decreasing the variance.  Unless we develop a way to do “smart” transparency, price transparency could potentially lead to price wars and other deleterious consequences.

Transparency is truly here to stay and I believe will become the way we do business in health care in the future.  The physician executive must embrace the transparency as a way to improve performance and improve value.  The physician leader must also help other physicians deal with transparency.  Transparency must become the cornerstone of physician peer review and evaluations.   Ultimately, transparency must be seen as a “friend” and not the enemy.  The physician leader needs to champion the process of “smart” transparency.

All physicians should implement evidence-based practices in every service line where evidence-based practices are available.  Of course, these practices are temporary and will always be enhanced as new medical knowledge is learned.  Today’s best practice may very well become archaic in ten years.  Furthermore, evidence -based practices do not apply to all patients.  National experts contend that today’s best practices may apply at best to only 85-90% of the population… and maybe less.   Protocols will never replace physician judgment.  I expect physicians to occasionally deviate from guidelines in the prudent practice of medicine, if in their judgment; it is not the right thing to do for the patient.  I simply ask that the physician document why the practice was not applied to that particular patient.  And if a physician deviates 90% of the time, I will question the physician, NOT the guidelines.  Bottom line, implementing evidence-based guidelines will decrease adverse results.  The physician executive must champion this process.   My mantra to hospitals is to implement best practices in every service line offered, where best practices are available.

Finally, it will become increasingly important to excel in the pay-for-performance process.  These performance indicators currently have three purposes:  1. they are evidence-based, 2. they are public and will be used to compare performance, and 3. they will affect future remuneration.  Obviously, all three are important.

If you add up the total liability to a hospital for at risk core measures, HCAHPS, hospital-acquired conditions, and readmission penalties, by fiscal year 2017, between 5-10% of the hospital’s total revenues are at risk!  No hospital can survive future Medicare revenues if another 5-10% is reduced as well.  Excellent core measure performance is imperative to stay competitive in that book of business.  Once again, the physician executive is in the best position to coordinate these efforts and improve the performance.

The physician leader must champion patient quality and safety.

Top on the agenda of the successful physician leader is the ability to embrace the process of data transparency, implement evidence-based practices in all service lines and be able to excel in the pay-for-performance process.

To successfully accomplish all three may be the most difficult challenge that the physician leader must face.

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