Physicians and quality metrics: They care…they REALLY care!

Nov. 14, 2016 / By Cheryl Manchenton, RN

So, this month I am taking a slight detour. Instead of continuing to dissect AHRQ version 6.0 changes, I would like to reflect on providers and quality. I promise to discuss AHRQ next month as there are more revelations in version 6.0!

Physician knowledge of quality metrics and programs has been historically limited.  We can’t blame them, as there are much more important things they need to spend their time and energy on such as patient care knowledge. But if we can squeeze in a little education on quality with physicians, are they interested?

The answer is an overwhelming YES!

I have had the privilege to participate in provider education on quality, and not just on HCCs.  I am referring to comprehensive education on the major CMS initiatives including the HAC Reduction Program, Value-Based Purchasing, the Hospital Readmissions Reduction Program, HCCs, Patient Safety Indicators and the Two-Midnight Rule. Across the board, the providers were interested and engaged. They may have been frustrated at times with some of the metrics, but as a whole were attentive and stayed well beyond the scheduled session time. 

Some lessons learned:

• Physicians want to do the right thing

There was not one session where a provider even hinted at manipulating the data or the documentation to better the metrics. Several participants noted that organizations/providers have and will continue to attempt to manipulate the quality metrics and they were disheartened by this. Almost every provider session included one provider that asked about oversight from CMS to ensure the integrity of the results. I agree with them and hope to see CMS publishing formal comments on this. I can imagine that CMS might use CERT technology to determine quality outliers that may need to be audited.

• Physicians care about quality of care

We presented case examples both from their organization and from other organizations. They weren’t shy about pointing out what they perceived as real concerns over quality of care as opposed to semantics of documentation. Several times I presented what I thought was a clear cut case of documentation opportunity that providers instead addressed as a quality of care concern.

• Physicians care about their performance

In my education sessions, I found that providers want detailed information about their own performance and want the ability to review individual cases. Years ago, I was involved in a case discussion with an OB-GYN department chair regarding a birth injury. The provider was most concerned about the lateness of notification. He wanted the ability to review his case (or that of his peer) in a timelier manner to ensure there were no quality concerns.

• Physicians care about the hospital’s reputation as much as their own

I met with independent practitioners, hospital-based practitioners, academic practitioners, mid-levels and residents. There was no difference in the level of concern based on the provider type. Concerns about reputation were equally distributed between themselves and the organization with which they were affiliated.

• They believe in the need for provider education on quality

Every provider was pleased they were receiving the educational content but wanted to ensure the entire provider body would also be receiving it. Time after time, they were appreciative of their group or individual session but would ask “Who else is getting this education?”

I am not as much surprised as encouraged by my interactions with providers on quality. It is as important (if not more) to educate providers on quality concepts as it is on general clinical documentation improvement concepts for accurate reflection of resource consumption and risk adjustment.  I believe we as an industry can do more to educate our providers and need to make it a priority. And I also believe we need to do a better job educating them on the finalized MACRA rule and MIPS and how quality is at the heart of this initiative as well.

If we teach it….they will come!

Cheryl Manchenton is a senior inpatient consultant and project manager for 3M Health Information Systems.