Finding the path to better hospital quality
Dr. Patrick J. Torcson has always been passionate about caring for the sickest patients and about ensuring the highest quality of care. So when he read Dr. Bob Wachter’s article in JAMA in 2002 showing that the movement to the hospitalist model was saving money without sacrificing quality or patient satisfaction, it led him to make the jump to become a full-time hospitalist (JAMA 2002;287:487-94).
Dr. Torcson established the hospital medicine program at St. Tammany Parish Hospital in Covington, La., in 2005, and still runs the program today. He’s also involved in the public policy and performance measurement committees at the Society of Hospital Medicine and serves as the SHM representative to the American Medical Association’s Physician Consortium for Performance Improvement, efforts aimed at ensuring that quality reporting programs are fair and relevant.
In an interview with Hospitalist News, Dr. Torcson shared his thoughts on the current quality reporting programs and the ones coming down the pike.
Hospitalist News: Physicians are doing more quality reporting now than ever before, do you think this leads to improved care?
Dr. Torcson: The evidence is mixed as to whether quality reporting and pay for performance actually improve outcomes. It’s important at the outset to distinguish between hospital-level reporting and pay for performance, and physician-level reporting and pay for performance. On the hospital side, we do actually have some results mainly from Medicare’s Hospital Quality Improvement Demonstration Project that showed that when you do public reporting, like on the Hospital Compare website, and you throw some money at the hospitals, that you will get improved quality as determined by adherence to the various performance measures.
On the physician side, there really isn’t any strong evidence showing that paying physicians on a differential basis actually improves quality. It’s hard to have good objective studies of that, but the ones that we have so far, mainly on the outpatient side, really do not show a clear distinction between quality reporting and pay for performance and actually improving quality of care. The lesson there is that maybe trying to do individual-level accountability for what really is systemic care may not work. But clearly we have to do something. We know that the U.S. health care system has tremendous variability in quality and unsustainable costs, so something has to be done to drive a performance agenda to fix this problem.
HN: How relevant are programs like Medicare’s Physician Quality Reporting System (PQRS) to hospitalists?
Dr. Torcson: In some respects it has to be relevant because hospitalists now provide more inpatient care than any other medical specialty. We know that hospitalized patients are the sickest and use the most resources. So performance improvement and performance accountability has to be relevant for hospitalists because of the importance of what we do.
That being said, the PQRS program as it’s currently designed has few relevant performance measures for hospitalists. Most of it was designed around an outpatient focus with that traditional model of doctors in the office also taking care of hospital patients and wasn’t geared toward the model that we have now where most inpatient care is provided by hospitalists. And the actual platform for how the performance reporting is done is not very easy for hospitalists to work with because we rely mainly on hospital-level billing systems to report data.
HN: The physician value-based modifier program is coming soon. What do hospitalists need to keep in mind about this program?
Dr. Torcson: If hospitalists are part of a group of greater than 100 providers, they are under a deadline of October 2013 to establish how they’re going to participate in this program, which will impact their reimbursement starting in 2015. This is something we’ve seen coming down the pike for a number of years. It’s important to remember that the Centers for Medicare and Medicaid Services has put only 1% of our Medicare allowable charges at risk with this pay-for-performance program. And for right now it’s only going to apply to large groups of greater than 100 providers.
The reporting period for the quality measures that will be used in this first iteration is 2013 for the payment adjustment that will occur in 2015. For the rest of us in groups less than 100, the performance period is probably going to be 2014 or 2015 for the payment adjustments beginning in 2017. It’s a small amount of money at risk for right now and it only applies to groups of greater than 100 providers. But definitely stay tuned.
