Value-Based Purchasing Raises the Stakes
Expectations on the Rise
SHM’s annual meeting this month in Grapevine, Texas (www.hospitalmedicine2011.org), will feature a session on improving HCAHPS scores, and Dr. Torcson has been working on a society task force educating members about how to be successful amid the coming changes. A Web-based toolkit in the works, he says, will highlight best practices for myocardial infarctions, heart failure, surgical care, pneumonia, and patient satisfaction to help hospitalists ensure they have the necessary skill sets. (SHM will offer a full platform of VBP courses by end of 2011.)
“At the individual hospitalist level, once you’ve decided to commit to serving that hospital-level performance agenda, we want SHM to be the place to turn to get the information on best practices and what you need,” Dr. Torcson says.
But first, says Bill Darling, a Washington, D.C., and Austin, Tex.-based partner with Strasburger Attorneys at Law, hospitalists will need a much stronger understanding of hospital expectations. Many hospital officials already are indicating that they’re leaning toward their own pay-for-performance programs to put individual doctors on the hook for negative financial incentives and penalties.
“Ultimately, in these value-based systems,” says Darling, a specialist in healthcare contracts and regulations, “the quality scores for physicians may affect their medical staff privileges or their membership in their group, or their ability to even move to another hospital.”
Moreover, hospital administrators are trying to instill a sense of shared responsibility in maintaining high value-based purchasing scores. “I cannot make a physician prescribe an ACE inhibitor when it’s appropriate to deal with heart failure, but the hospital takes a hit for that,” says Dee Rogers, RN, director of quality and risk management at Magnolia Regional Medical Center in Magnolia, Ark. “Not that I want to see people get their hands slapped—I want to see equal accountability.”
Like other hospitals, Rogers’ 49-bed rural facility is tracking doctors’ performance on quality measures and guidelines as part of its credentialing process. Many facilities are starting to include more comprehensive evaluations as part of their contract renegotiations. Magnolia has one weekend hospitalist and is conducting a feasibility study on whether to launch a full-time hospitalist program on weekdays. If the hospital pursues that program, Rogers says, she’d like to see upfront expectations built into the doctors’ contracts.
Seven Tips to Prepare for Value-Based Purchasing
- Pick your partners carefully. Lawyer Bill Darling says hospitalists must understand the terms of any contractual arrangement they enter and who their teammates will be for value-based purchasing. Are others likely to hold up their end of the bargain? If not, how much risk will fall upon hospitalists?
- Accept personal accountability. The reality is that more hospitals are demanding responsibility from individual physicians and posting their performance on key measures. Hospitalists might not be able to control how others respond, but embracing their own responsibility now will help ease the transition to an era of more public accountability. Become board-certified. Doing so, says Patrick Torcson, MD, will augment the disease-specific knowledge and quality-improvement skills necessary to be successful with value-based purchasing.
- Talk to your nurses. Not being on the same page can drag down both doctor-communication and nurse-communication scores in the eyes of patients who assume a medical team is regularly sharing information, says VHA Inc.’s Trent Haywood, MD.
- Make eye contact with your patients. If doctors sit with patients and make direct eye contact, even if only for five minutes, “it makes the patient feel like they’re being validated,” says Dee Rogers, RN. Satisfaction rates will “go through the roof,” she says.
- Establish upfront expectations. Remind-ing patients of what they should expect during their hospital stay, says Patricia Richardson, RN, RCP, director of quality and risk at Samaritan Hospital in Moses Lake, Wis., might help them put their experience in the proper context and not hold the facility to the same standards as their own homes.
- Pay attention to details and be adaptable. PeaceHealth’s Laura Dietzel says a two-sentence section in CMS’s proposed rules spurred her healthcare system to quickly adapt. PeaceHealth shifted away from several measures it had been focusing on after it became clear they would be retired from the competition “in the near future,” according to the rules.—BN
