Tufts Medical Center: Blurring the LinesUniversity HealthSystem Consortium

Annual Conference 2012

Friday, September 14, 2012

Blurring the lines

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Value

Physician Hospital

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Context – Organizational alignment

• Tufts Medical Center– Founded in 1796– 350 bed full service medical center – Located in downtown Boston– Primary teaching hospital for Tufts

University School of Medicine– 44 GME programs with >400 residents

and fellows

• Tufts Medical Center Physicians Organization (Tufts MCPO)– Academic multispecialty group

practice – >500 physicians organized into

17 clinical departments

Goals of professional practice evaluation

• Quantitative assessment of provider performance in multiple domains

• Optimize the use of existing data repositories• Assist the Chairs in the development of these reports• Align physician and hospital goals and objectives• Optimize our organization’s delivery of value based

healthcare

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Organizational Alignment and Leadership Focus

Department Chair

Physicians Organization

Medical Center

Medical School

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Look for leadership levels that provide the greatest breadth and focus to provide leverage for your initiatives. In most organizations, the departmental chair is in the key position to drive academic, hospital and physician performance.

Why evaluate physician performance?

• Joint Commission

• Pay for performance

• Public perception

• Improving patient care and experience

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Joint commission -

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Focused Professional Practice Evaluation

Ongoing Professional Practice Evaluation

Continuous Professional Practice Evaluation

Pay for Performance

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Financial Risk

Metrics and performance

measures

Physician Hospital

Physician

Hospital

HMO putting PCPs at risk for HEDIS & experience measures

Global and Bundling

VBP putting hospitals at risk for performance on quality, safety and HCAHPs performanceHMO putting PCPs

at risk for hospital Q, S and HCAHPs measures

Depending on the details and structure of the contract – both physicians and hospital will have financial risk

Michael Wagner, MD 2012

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Pay for Performance

MHQP website

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Public Perception

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What is Physician Performance?

Domains

– Medical Knowledge– Patient Care– Practice Based Learning

and Improvement– Systems Based Practice– Professionalism– Interpersonal and

Communication Skills

Outcomes

– Processes of care

– Safety / Harm

– Patient experience

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DO – DOC – DATA

Physician Facility

Inpatient X X

Outpatient X X

Combined X X

Forms/EMR

CDI

MR

Docare provided

Documentcare documented

Datacare codified

Michael Wagner, MD 2012

Figuring out physician performance is like a puzzle

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The essential point of physician evaluation is to focus on the key aspects of the picture. You do not need to complete the entire picture in order to understand the physician’s competency and performance. Unlike a puzzle you might complete with your kids, you don’t start at the edges, but start at the central aspect and work your way out.

Data – you have more than you think

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Patient experience

• MHQP• PG ambulatory• PG inpatient

Inpatient data

• Core Measures• Safety events• UHC repository• TSI

Ambulatory / outpatient

• EMR reporting• Meaningful use• Repositories• Billing data

Aggregate Physician

Performance

Working outline of process

UHC

Report by MD and peer group

Press Ganey

TSI

Summary Reports

IDX / FPSC

MQIP

Blood

HIM

Data pulled by specialty and provider

Divisional DatabasesOne App

Validation process

MD leadership / MD feedback

OPPE / FPPE / PO

Fix errors

Fix process

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Lessons Learned

• Attribution• “Those are not my cases.”

• Documentation and Coding• “The report is wrong, I didn’t have any accidental punctures.”

• Data lags• “This data is too old.”

• Understanding of metrics, risk adjustment, etc.• “This doesn’t make any sense. Why is this important?”

• Integration challenge• “We use another system for that.”

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Adjustments made

• Focus with flexibility

• There are data lurking everywhere

• Clinical data is most helpful and relevant – administrative data is the most problematic.

Next steps

• Surgical specialties– Focus on patient safety indicators

• Medical specialties– Develop method to compare physicians based on their clinical

focus– Non-procedural areas – finding quality data that is attributable at

individual physician level

• Alignment of annual Chair goals with hospital, VBP and other quality, safety and experience initiatives

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Thanks

• Brian Collins• Karen Reed• Linda Nolan

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Questions