By Emilie J DiChristina, MBA for Practicefirst
To many the requirement for quality measures adds just one more layer to the complex nature of providing health care.
The question is…Why? I mean do any health care providers wake up in the morning planning to provide sub-standard care? Of course not!
It is just seems to be a bit too much, particularly for older physicians and those facing higher costs and decreased revenues.
If we look at it from perspective of health care costs and the cost to the insurance carrier, the requirement to tie some financial conditions to quality seems to be late in coming. In 2009 the estimated waste in health care spending was somewhere between $600 – $850 Billion dollars as published by Thomas Reuters, Analytics in Healthcare.
By far, the majority of the waste was tied to unnecessary care, uncoordinated care, and avoidable care. IF an increased focus on quality can reduce the waste, it is surely worth putting a financial incentive on the effort. The key is to find out how to meet the quality incentives without breaking the bank (or the provider’s back) to do so.
If we examine the statistics propagated by the CMS, Office of the Actuary, National Health Statistics Group, we can see why the emphasis for saving money through quality initiatives lands pretty squarely on the shoulders of the provider. Of the more than $2.3 TRILLION spent for health care, hospital, nursing home and medical provider payments account for 58% of the expenditures – further illustrating the role of the provider in providing quality and efficiency for overall lower costs.
Why the provider? It is the provider who has the “power of the pen”, and whether the quality issues arise in the hospitals (31% of health care expenditures), the provider’s office ( 21% of expenditures) or the nursing home (6% of expenditures)– it is the physician who writes the referrals, the prescriptions, the orders, and provides the information to the clients as to why and how their health can improve.
When physicians and health care providers look to the quality indicators being offered by CMS, as well as those being promulgated by the private insurance carriers, it can make the job of meeting the incentives seem even more daunting particularly for those in primary care. Are you going to choose to focus on smoking cessation, asthma management, diabetic care, something else?
Where will you get the biggest bang for your buck and help the most patients at the same time? You have to know your practice health demographics, and like I said in primary care this leads to a lot of choices. If you are a Radiologist, the choices for quality measures are less, and less onerous to achieve.
Step # one should be to first evaluate diseases or conditions result in the majority of the visits to your practice, or of those conditions for which you most often provide care in a hospital or nursing facility.
The following list is an estimate of the 10 most expensive diseases as calculated by Charles Roehrig, health economist at the Altarum Institute in Ann Arbor, Michigan, based on 2005 data
- # 1 Mental Health Disorders @ $142.2 Billion and an annual growth rate of 6%
- # 2 Heart Disease @ $123.1 Billion and an annual growth rate of 5%
- # 3 Trauma @ $100.2 Billion and an annual growth rate of 6%
- # 4 Cancer @ $99.4 Billion and an annual growth rate of 7%
- # 5 Pulmonary Problems @ $64.6 Billion and an annual growth rate of 6%
- # 6 Hypertension @ $ 50.2 Billion and an annual growth rate of 9%
- # 7 Osteoarthritis @ $48 Billion and an annual growth rate of 9%
- # 8 Back Problems @ $40.1 Billion and an annual growth rate of 9%
- # 9 Kidney Disease @ $35.9 Billion and an annual growth rate of 13%
- #10 Diabetes @ $35.8 Billion and an annual growth rate of 8%
Using these diseases, look at the rates in which they occur or are seen in your population – those are of course the conditions which you should choose for your PQRI/PQRS quality measures, and for which you should be willing to work with your affiliated hospitals and nursing homes.
Not surprisingly, the diseases listed above are where the private payors have placed their emphasis, so the next step is to find ways to address the quality measures without adding extra expenses to your practice and without introducing inefficiencies such as tying up FTE’s to perform cumbersome data mining.
In Part Two (see April 2012 Edition), we will look at ways to meet indicators and possibly even lower costs and introduce efficiencies while doing so. If you have an immediate need, please contact Practicefirst at firstname.lastname@example.org to request a con