What Makes a Medical Practice Great? Part 1

Friday, February 19, 2016 | Larry Sobal

Throughout my career I’ve had a chance to work in, and consult for, a number of medical practices. As someone with a chronic disease, a caregiver for two parents who had chronic diseases, and a parent of three sports-active kids, I’ve also been a patient or family advocate at my fair share of medical practices, including “national brand name” organizations.

At some time or another, often in the strategic planning process or reflecting on a personal experience, the question comes up: “What characterizes a great medical practice?” I’ve usually countered that question with one of my own, namely: “From whose perspective are we judging medical practice performance?”  This typically leads to a follow-up question: “Which of these is most important?” 

Here are some things to consider as you think about the answers to the above.

Let’s start with patients. You can make a strong argument that they should have the final say on determining medical practice greatness. After all, medical practices exist to diagnose and treat the patients who seek their care. How many of you in medical practices have some version of the words “patient centered” in your mission and or vision statements?  I’ve rarely seen a medical practice that doesn’t, and those words are often posted on the wall in the waiting room. Even if you’ve taken the time to define what that means, is the definition the practice’s definition or have you gone so far as to really seek out patient perspectives of what they want and need? 

Is great cardiology care measured as it was delivered today or as the outcome of the disease over years of treatments from that practice?

The fact is, patients come to receive services from a medical practice with a myriad of expectations, and there are no simple means to define, identify, and effectively compare them. CG-CAHPS is one standardized tool to measure patient perceptions of care delivered by a provider in an office setting. However, it is not yet being consistently utilized, and its results will offer only a partial answer, especially if you feel a patient’s perspective should incorporate some objective longitudinal measure of the impact the medical practice had on patient’s actual health status. In other words, is great cardiology care measured as it was delivered today or as the outcome of the disease over years of treatments from that practice?

How about the perspective of physicians on assessing medical practice greatness, for who better to judge if a practice’s performance is exceptional?  Since physicians are often at the center of the clinical process and therefore have a broad perspective of all the aspects of care and services delivered to patients, is that perspective most valuable?  Maybe, and more likely in smaller practices, but my experience is that while many physicians have a good understanding of the practice’s performance in meeting the needs of their own patients, they rarely get to really understand what their colleague has been doing in the exam room next door for the past 10 years or the larger picture of the practice performance as a whole. Plus, consider all of the non-clinical activity—such as scheduling, billing, education that often happens in processes outside the physician’s line of sight.

In addition, it’s not unusual that physicians, outside of their training and personal practice, never see a broad spectrum of other practices unless they are a patient or caregiver themselves, or take advantage of site visits to other practices such as the MedAxiom Impact Groups.

What about payors—are they in the best position to judge and identify medical practice greatness?  For purposes of this blog, let’s focus on CMS. If you think about it, CMS oversees and pays for almost half of all health care in the U.S. This means CMS has a vast amount of data, mostly on the volume and cost of services billed by medical practices. It’s impressive what you can find using their huge publically available data set. Unfortunately, despite being a source of “Big Data” in health care, this information offers little insight on the quality or value of care provided. For now, it’s almost all based on billing data and, unfortunately, you don’t bill for talking to a family about how to handle mom’s growing dementia nor is there a billing code for providing reassurance rather than ordering another test about one’s slow-growing prostate cancer.

So, this means that it has to be the employees at the medical practices, right?  If I want to know about the best surgical group, I usually ask the OR nurses. If I want to know which specialty group has great access, I might ask the schedulers in primary care. It’s been my experience that when conducting employee interviews as part of a practice assessment, they usually have the most insight about what is working and not working in their own practice (as well as many others in the community). But often this information is perceptual, and lacks the value of having seen the objective data, such as from quality registries and other sources.

Where does this leave us? Is there actually such a thing as a “great” medical group?  To get the answer to that, you’ll have to read next week’s blog. In the meantime, answer two questions for me:

Who is best to judge medical practice greatness?

On what basis should it be judged?

 

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

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