Quality Management Committee

by Dr. Ali Sarram, M.D.

The march towards a quality-based healthcare system has been gaining steam over the past year. Not a day goes by without an email, a phone call or a reminder that physicians are being watched, measured, evaluated and judged based on their ability to provide cost-effective, quality healthcare.

While the government has stalled in the debate on how to deliver quality healthcare, private insurance companies have quietly moved in that direction with very little input from those who actually deliver healthcare. Just last month, I got a notice from United Health Care listing all available imaging facilities in my area. This categorized these centers based on cost, and cost alone. There was no mention of quality, availability, ease of use, customer service and all the other measures that we as ordering practitioners and consumers of healthcare regard as valuable. This list, in some form, put me on notice that my utilization of imaging was being monitored.

I got another notice from another large private insurance company that I had made their A-list. This puts a star next to my name (the last time I had a star next to my name was in 1973, when I was particularly good on a warm Kindergarten day!). This star means that patients will be directed to me via the insurance company’s website, and they will be coerced into seeing me with lower co-pays. While this works nicely for me, I have no idea how I earned this star. To make matters worse, if I did not earn a star, I would not know why, how and when I can earn my star back. This process is not transparent, and was created with little to no input from physicians.

It appears that we are evaluated not only based on what happens in our own practices but also based on our associations with imaging facilities, outpatient surgery centers, labs and hospitals. The ratings of facilities that we associate with will invariably affect our ratings as independent practitioners. This solidifies my assertion that physicians need to be involved in what happens outside their practices.

At the Quality Management Committee, we are very active in improving the quality of care delivered at TMCA and affiliated facilities. Over the past year, we have improved our publically reported quality measures. We have improved core measures. We have improved HCAHPS scores and have made significant strides in quality measures that actually matter: such as prevention of DVT and PE, ventilator associated pneumonia and surgical site infection rates. Yet much work remains. The oft quoted core measure is an elusive goal. One colleague’s oversight in checking the right box is all that is needed to go from green to yellow to red. Patients have ever increasing access to this information and make healthcare decisions based on these ratings. Physicians often perceive this information as irrelevant and inaccurate, but the consumers are aggressively pushed to utilize this data when making healthcare choices. If you have any doubt about this, I strongly urge you to visit www.healthgrades.com to look up your own ratings or visit www.hospitalcompare.hhs.gov to see how your hospital affiliation can affect your practice.

This is a small example of how “value based purchasing” is alive and well. The government has set the stage, and insurance companies have ran with the ball before the whistle was blown. As physicians, and for the sake of survival of our own practices, we have no choice but to be active participants in this process. I strongly encourage each and every member of our medical staff to get involved with the Quality Management Committee and the medical staff structure.