Quality improvement: A race with no end

Deb Beaulieu

Deb Beaulieu

If you've been reading FiercePracticeManagement for a while, you might have guessed that April 16 was a big day in my household: Marathon Monday. The Boston Marathon, to be exact. Without getting too off track (no pun intended) about the mystique of the historic event and the sport it embodies, I bring it up as an example of quality measurement at its most basic level.

If you want to evaluate a performance, it doesn't get much simpler than measuring time over a set distance, right? If you followed Monday's race or happen to live in New England, you know that summer made a surprise one-day visit to Boston, with temps hitting the upper 80s at a good 30 degrees hotter than normal. Without the usual season to acclimate, runners suffered. Some of the strongest and fittest of the athletes ran the slowest, most brutal races of their lives. Even the fastest marathoner in the world was forced to drop out at mile 18. The most relentless of competitors were simply happy to finish.

So, I ask you, if you were to evaluate the quality of those performances--slow, painful and decidedly not pretty--how would you rate them? By my math, a five-hour marathon under those conditions, with that kind of perseverance, is probably equivalent to a run possibly hours faster on a perfect day.

But healthcare quality, even on its very best of days, is never close to as cut and dried as something like a race, where all of the competitors still place in one sequence from first place to last, no matter what.

Consider just a handful of the problems Medicare will face in figuring out how to pay physicians using its new Physician Value-Based Modifier program in 2015, as described by Kaiser Health News' Jordan Rau: "You don't want to compare one type of specialist to a different type that isn't exactly the same. And then they also have the challenge of figuring out--and this is probably the hardest thing--how much resources that doctor uses of Medicare. That is proving very challenging because you can't just take a look at the Medicare billing of that doctor, but you have to figure out what they're doing: Are they referring too many people to high priced specialists and not intervening early enough? Are they having too many lab tests? Conversely, you want to make sure you're not thinking that someone who is not doing enough is actually doing a great job."

Or look at our other lead story about how different types of patients perceive quality of care (who likely don't care if it's excellent according to how someone else defines it: "The researchers found that only 39 percent of black women said they got 'excellent' care compared to 60 percent of whites and 62 percent of Hispanics," Reuters reported. "But, the researchers found there were no differences in the actual quality of care black women received compared to whites and Hispanics."

Finally, think about how the various definitions of quality play in to the way doctors refer one another to patients. Hint: Service may trump outcomes.

Now, I realize that "quality" is a broad term to describe many different ideas previously listed, not the least of which are patient satisfaction and patient experience. You can split hairs and refine definitions all you want, but the reality is that many of you are ultimately going to be paid, if you're not already, based in part on how well you satisfy patients, how well you communicate with them, how well you get them to engage in their own care and how you perform clinically. Oh, and you're going to have to do it all cost-effectively.

Opinions are strong as to whether these trends are good or bad, but it's looking more and more like they're unavoidable. With all of this in mind, how do you, as a practice, evaluate the quality of the care you provide? If you're doing your best, it's not always going to be pretty or necessarily fill all the requisite check-boxes of success. All you can do is show up every day and give it all you've got. - Deb (@PracticeMgt)