Finding the path to better hospital quality

HN: Do you have any tips for how to make quality reporting programs like PQRS less onerous for hospitalists?

Dr. Torcson: Hospitalists should try to take off their clinical hats and even their quality improvement hats and think in terms of practice management. For now, PQRS is voluntary, pay-for-reporting only. So the focus for now is getting your reporting infrastructure in place and that is tied to how you do your billing. It’s a matter of doing the administrative work to see how you submit your claims to Medicare and getting used to reporting the quality data codes, which are part of the PQRS, to those billing codes.

For PQRS, you only have to choose three performance measures. The PQRS has over 260 measures in the program and only 10 are really applicable to hospitalists. You don’t have to hit a home run. Just choose the three measures and figure out from a practice management standpoint how you’re going to attach the quality data codes to your billing codes to get in the reporting game. That’s the best starting point.

HN: Do you think we’ll ever see a payment system based completely on quality rather than volume?

Dr. Torcson: The U.S. health care system is going to be doing a lot of experimentation with alternative payment models. A driving force is to shift financial risk from insurance plans and other payers to providers. That’s going to happen in various payment models like bundling or capitation or the accountable care shared savings methodology.

Pay for performance isn’t necessarily the key to improving care, and regulating change doesn’t seem to work either. What we hope is going to happen is that we’re going to figure out better ways to manage chronic illness and to perform care coordination for the 5% of the population that accounts for 50% of the health care resources.

Looking forward, I think that success for an individual hospitalist is really going to be achieved by aligning with the hospital-level performance agenda. Don’t just think in terms of the individual physician and how you’re going to perform, but really think at the system level.

For hospitalists, in particular, we have a great opportunity through alignment with the hospital-level agenda to really make a difference in terms of how we improve the quality of care and are accountable for costs.