“But I have been caring for patients and been working in healthcare for many, many years. Why do I need to change the way I care for patients?” This is a question I often get when working with practices that have an outstanding track record for patient outcomes. However, measuring the quality of healthcare and using those measurements to promote improvements in the delivery of care is important to every clinic, even those with outstanding records.
With the fast growing changes in healthcare it is extremely important to make sure that patients are still getting quality care in a fast-paced practice. When practices already have a good system in place and then a change has to be implemented it is extremely hard to get out of that routine. With performance measurement followed by improvements on those measures, your already well-oiled functioning practice will perform even better.
As we consider the effect of this new quality measurement and reporting effort from MACRA, there is much to get excited about. Many measures are quite hefty with evidence-based links between process performance and patient outcomes. It is not possible to know how many improvements would have occurred in the absences of standardized measurement, public reporting, or the threat of CMS penalties. Practices should focus explicitly on maximizing health benefits to patients. Achieving this goal requires establishing criteria to separate measures that advance from those that do not, and replacing poorly performing measures with better ones.
Room for improvement is always a factor in a clinic setting. Below are 4 ways to reach that goal for improvement.
- A measure must be based on a strong foundation showing that the process addressed by the measure, when performed correctly, leads to improved outcomes.
- The measurement strategy must accurately capture whether the evidence-based care has been delivered.
- The measure should address a process quite proximate to the desired outcome, with relatively few intervening processes.
- The measure should have minimal or no unintended adverse consequences.
With any implementation of improvement there are challenges. These challenges are manageable:
- A narrow focus on quality measures may miss the importance of improvements of care for patients.
- Accountability measures may require some adaptation for the assessment of care that serves as a useful framework for identifying accountability measures in clinic settings.
- Some unintended adverse consequences can be anticipated and avoided during the initial evaluation of a measure, others may not become evident until many clinics use the measures.
Eliminating measures that do not pass these accountability tests and replacing them with ones that do will reduce unproductive work, enhance the credibility of the providers and the clinic itself, and increase the positive effect that all these programs will have on health outcomes of patients.