What Makes A Medical Practice Great ? Part 2

Thursday, February 25, 2016 | Larry Sobal

Last week in Part 1 of this blog I ended by asking two questions: Who is best to judge medical practice greatness and on what basis should it be judged? This week, in Part 2, I'll do my best to answer those questions.

My answer about judging a medical practice is that anyone absolutely has a right to, but nobody is absolutely right in doing so. In other words, patients, physicians, employees, payors, and others who interact with a medical practice all have a perspective, based on their unique set of experiences, and therefore are in the position to offer judgement on how “great” a medical practice is. But as I noted last week, they all have limited, and thus biased, perspectives.  

A good analogy is the parable about various blind men touching an elephant and each one describing (very differently) what they think it is. Broadly, the parable implies that one's subjective experience can be true, but that such experience is inherently limited by its failure to account for other truths or a totality of truth. Similar to this parable, judging a medical practice can also involve a range of truths and fallacies, depending on your interaction with it. Therefore, I don’t think any of the key stakeholders (patients, physicians, employees, payors, etc…) have an absolute advantage over the others when it comes to assessing greatness.

I don't mean to imply that there can’t be some fundamental and consistent set of criteria that might allow comparability between practices, and therefore a method to determine relative greatness of one practice over another. In fact, in my opinion, the best place to start with would involve the Quadruple Aim. As I blogged about back on December 24th, the Quadruple Aim takes IHI's more commonly known “Triple Aim” and adds a fourth critical element—Improved Clinician Experience.

Using quantifiable aspects of these four pillars, as detailed below, is how I would judge the relative “greatness” of a medical practice.

A reasonably objective comparison of Clinician Experience can be attained through well-designed surveys that explore aspects of an organization’s culture, engagement, satisfaction, and (dare I suggest it) joy. According to Towers Watsons 2012 Global Workforce Study, it is imperative that we go beyond the typical assessment measures and include questions to determine how effectively we are enabling workers with internal support, resources and tools, as well as assessing whether the work environment is energizing to work in because it promotes physical, emotional and social well-being. It should come as no surprise that joyful employees are more productive, easier to work with, care more about the outcome and produce higher-quality work—and that would seem to be a strong foundation for a pretty great medical practice.

The other three pillars to medical practice greatness also can be quantified, and therefore judged, to some degrees and in various ways. As mentioned in Part 1, the CG-CAHPS tool is becoming a standardized methodology to assess Patient Experience. It is by no means complete, and could be supplemented with additional questions assessing education, care transitions, etc… but it does a pretty good job of quantifying aspects of experience assessing aspects of a patient's experience with a medical practice.

Likewise, there are currently methods to assess aspects of Better Clinical Outcomes, albeit limited and currently more developed for some disease states or physician specialties than others. Nonetheless, as this science develops and begins to incorporate Patient-Reported Outcome Measures (PROMS), we are slowly increasing our ability to capture whether the clinical services provided actually improved patients' health and sense of well-being. This will be bolstered by last week's announcement from CMS and the American Health Insurance Plans that they are working to create more a more standardized set of quality metrics and the release of some initial proposed sets of metrics.

What I suggest is that a medical group seeking greatness take advantage of the many ways it can assess and improve its performance.

Finally, as the reimbursement methodologies begin to move away from fee-for-service to various value-based methods, the need and ability to understand the relative Cost of Care is also an improving science. In terms of a medical practice, this would involve assessing the cost of not only its delivery and selection of services and treatments to patients on a risk-adjusted basis, but also include the costs of the treatment decisions on a longitudinal or episodic basis that occur downstream from the practice.

I would be remiss if I did not add a comment here related to clinical documentation. A great medical practice, regardless of the manual chart or EMR it uses, must be highly accurate and proficient at capturing, coding and billing for the work it performs. The linkages between accurate documentation and quality are critical, whether it involves complete capture of HCC’s, medication reconciliations, etc…in addition to being properly reimbursed for the work that was actually performed.

So, is there such as thing as medical practice greatness?  The answer is both “yes” and “no.” It is “no” in the context that you can’t really determine medical group greatness today in a totally inclusive and objective way. And it is “yes” in that there are plenty of medical practices out there that are the best at what they do, at least on some dimensions, with various ways to begin comparing the performance of one against others. For example, MedAxiom offers two forms of comparative analysis to our heart program members, these being our annual release of MedAxcess survey data (800 metrics of heart program performance) as well as our annual MedXcellence survey, which will provide some comparative analysis on Ambulatory practice, Cardiovascular Service Line, Cath Lab, Nuclear and Echo attributes.

What I suggest is that a medical group seeking greatness take advantage of the many ways it can assess and improve its performance. A practice can steal some innovations from other practices (e.g.: MedAxiom meetings are a great place to hear other practices present their successes) and utilize the growing number of sources that offer you a chance to assess yourself against others.   Also, spend time collecting and examining the perspectives from all the stakeholders that I have mentioned, develop your own Quadruple Aim set of metrics, and use that information to make yourself better than you were before. In the words of Horace Mann, “If any man seeks for greatness, let him forget greatness and ask for truth, and he will find both.”

 

---

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.

 

---