Improving Quality and Efficiency:
The New Pay-for-Performance Metrics
New pay-for-performance contracts that began earlier this year are changing the way hospitals conduct performance improvement through increased physician engagement.
“The BWPO has been working with primary care physicians for years to support improved performance on measures in the areas of quality, efficiency and use of technology,” said Jessica Dudley, MD, chief medical officer for the BWPO. “The changes require increased specialist engagement with the identification of specialty-specific quality metrics, and the PO is committed to working with them to engage all of our physicians in performance improvement going forward.”
To help identify metrics, senior physicians have been designated as directors of Performance Improvement (DPI) for each of the 16 BWPO departments. These directors are responsible for spearheading the departments’ pay-for-performance improvement efforts, including setting an agenda with relevant performance improvement action plans, engaging faculty in measurement, reporting performance data to the department and collaborating with their counterparts throughout the Partners system to set the same metrics.
McCallum “Cally” Hoyt, MD, is the director of performance improvement for Anesthesiology, Perioperative and Pain Medicine. “For metrics, we need to choose something we can reliably measure and also prepare guidelines for how to achieve our goals,” she said, adding that the department has been paper-driven until recently, making it difficult to measure certain metrics easily. “A lot of the work this year involves defining what the metrics are and will be in the near future, and determining how to establish the baseline for measurement.”
The department already has two performance improvement measures in place: timely administration of antibiotics prior to incision to reduce likelihood of infection; and participating in the pre-procedure safety pause, which includes a recitation of a patient’s allergies, and statements on the airway, the plan to keep a patient warm during the case and whether IV fluid access is adequate for anticipated needs and blood is available, if needed.
“Those are two areas we’re already measuring and plan to expand to our other areas outside the ORs,” Hoyt said.
A metric Hoyt is considering for 2011 is body temperature regulation and ensuring that a patient’s temperature is at 35.5 degrees Centrigrade by the end of a case or soon after arrival in the recovery area. “We know that cold patients may develop coagulation problems, a greater risk for tissue infection and may require prolonged hospital stays,” she said. “The American Society of Anesthesiologists recently developed a statement on temperature regulation, and we want to not only continue to measure temperature, but also define strategies to actively manage a patient to achieve this goal if a patient is running a low intra-operative temperature.”
Hoyt plans to define the metric with help from department members and establish a baseline in 2011. Then beginning in 2012, she can set improvement goals around the metric.
“Everybody wants to do what’s best for their patients,” Hoyt said. “Establishing metrics will help everyone practice closer to the evidence-based recommendations. I think this is an opportunity not only as a department, but also as an institution, to engage everyone and identify what those best practices are.”
One area that all physicians must be attentive to is effective use of the EMR. One-third of the pay-for-performance withhold return is tied to effective use of the EMR with the contracts that begin this year. “This is critical for efficiency and earning back our withhold,” said Dudley.
She added, “These new contracts give us a great opportunity because they provide us more autonomy in identifying metrics we as physicians want to focus on. Increased involvement of our physicians in the identification of relevant metrics and the development of programs to improve our performance on these metrics will help us deliver the highest quality of care in the most efficient manner.”