I remember a few years ago facing the daunting goal of 100% compliance with the Core Measures for my six hospitals. Physicians argued that 100% was simply impossible.
Now in 2013 most hospitals have exceeded 99% and many are approaching 100%. So processes can be hardwired and “fixed”. NOw 100% is no longer a pipe dream. But has improving clinical processes resulted in improved clinical outcomes? Several studies question that.

In the next few years the P4P metrics will transition from processes to outcomes. In FY13, the process metrics accounted for 70% of the total pie. By FY16 they will comprise only 10%– the remainder being HCAHPS, spending per beneficiary and mortalities– all outcomes.

Outcomes!! Unlike processes there are no simple fixes here. Outcomes cannot be hardwired or guaranteed. There are no magic bullets.

So as responsible medical leaders, what do we do? Physicians again cry impossible. Every hospital wants to be in the top decile– but by definition, only 10% will.

And don’t forget, the data for P4P tends to lag about 2 years. Our FY16 score will largely be based on our performance today. We cannot wait !!

Fixing process and implementing best practices are merely the beginnings. Where do we go from here?

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