On March 13, Ronnie Brownsworth, M.D., CEO of the Piedmont Clinic, and executive vice president of Piedmont Healthcare, both in Atlanta, co-presented on a Healthcare Informatics webinar with HCI Editor-in-Chief Mark Hagland and with Marc Golberg, general manager of the Provider/Payer/ACO Market Sector division at Recombinant By Deloitte.
Working with a clinically integrated IT platform from Recombinant By Deloitte, Dr. Brownsworth has been leading his colleagues in the Piedmont Clinic, an independent practice association-based organization with 380 employed physicians and 520 community-based physicians in 150 locations in metropolitan Atlanta, steadily towards accountable care-based healthcare delivery. Among the tools and systems he and his colleagues have put in place at Piedmont Clinic have been an integrated platform serving physicians using a variety of electronic health records (EHRs); a built-in physician portal; clinical data integration and a performance reporting system; population health management dashboards; deep-dive, real-time analytics capability; and, overall, at IT foundation in preparation for private-sector accountable care, with that foundation facilitating intensive quality outcomes reporting and continuous clinical performance improvement.
Clinical performance improvement has been rapid. Even in the first year of the quality-driven initiative, physicians at Piedmont Clinic improved significantly in reducing the incidence of community-acquired pneumonia- and congestive heart failure-driven hospitalization; improved with regard to physicians’ performance on SCIP measures; improved colon cancer screening and pneumococcal pneumonia vacation; and improved with regard to blood pressure control among diabetic patients.
Dr. Brownsworth spoke with Mark Hagland shortly before the webinar, to discuss his organizations achievements and aspirations. Below are excerpts from that interview.
You have a large number of relatively small physician practices working under the umbrella of Piedmont Clinic, correct?
We have a lot of independent one- and two-physician offices, but also a large orthopedic clinic with 17 physicians, and some hospital physician groups with 20 or so. Our employed group is in 30 locations, some as big as 20 physicians strong, and as small as one or two. Eighty percent are centered around or geographically close to the five Piedmont hospitals. We have a 480-bed tertiary hospital, community-based, in the heart of Atlanta, and four sole-county hospitals.
Ronnie Brownsworth, M.D.
What was the origin of your connection with Recombinant?
I was brought on four-and-a-half years ago to move Piedmont from its then-platform to a clinically integrated platform. And I was looking for a clinical platform, one with performance improvement in it. We developed our own platform, built by Recombinant; it’s not an EHR. In fact, to force all of our physicians to go to one specific EHR would have been very expensive for those practices to shift to, and would not have allowed us to move forward. What this platform does is that it allows us to take 100 percent of the billing and patient information and the information from all the hospitals, and to understand the population of patients we touch. It’s a population health platform as well.
When did you go live with the platform?
We went live in January 2010. They put in place for us a platform that allows for the transference of data to us; we had to have the capacity for information to come out of 150 different billing systems, to be delivered to our analytics database. Then they helped us build the scrubbers, because certain information cannot be held in the database—in Georgia, that includes patient information about STDs, mental illness, and drug and alcohol treatment, so that data must be scrubbed from our database. Also, some of the physicians are part of larger physician groups, with physicians who are not members of our organization, and we have to use data scrubbers to make sure that non-affiliated physicians’ data doesn’t get in. Must be mapped to the correct cells. Once the data gets scrubbed, it goes into the system, and it helps us build HEDIS measures and population health measures. And they also helped develop for us a web portal strategy for our physicians.
There’s a physician portal built into it as well?
Yes. And part of the analytics capability of it is that when the information comes to the physician on a dashboard behind that portal, the physician may want to know their own individual data; how they’re doing within their local group; within their specialty; or how the clinic is doing as a whole. And they have the ability to do that. Likewise, a physician may question the results—how did they get this? So they can drill all the way down to their individual patients’ data. And while they can see wrap-up data on all the patients from all the physicians, they can’t see individual patients’ data. That’s how we comply with HIPAA privacy requirements.
Let’s talk about some of the categories of metrics you’re working with.
We have several categories of metrics we’re measuring; we also have hospital-specific metrics. So we’re getting core measures from hospitals and never-event data from the hospitals, and pathway compliance by the physicians in the hospitals. This represented the beginning for us of being able to look at the entirety of patient care. So we have population health metrics, which include what may be more around HEDIS-type scores for preventive care, diabetic care, immunizations, etc. Our next wave now is around admits per 1,000, readmits, and clinical utilization. So we’ve been measuring clinical outcomes, and now we’re going to be moving into clinical utilization.
The other major area we’re working on is outcomes measures within PQRS [the federal Physician Quality Reporting System]; each specialty within our organization will need to choose at least three PQRS measures to work on; and it aligns with the work we do for CMS [the federal Centers for Medicare & Medicaid Services]. But we do not just do this performance improvement work on behalf of our Medicare patients; we do it on behalf of all of our patients. And if we’re going to do the work, it needs to be the same for everyone.
And our next level of utilization of the system will begin to look at patient utilization; and that work will help us to prepare for ACO development. We chose not to become a Medicare ACO at this point; we think it’s the right direction to go, but the economics of it does not make it doable for us within three years. And we think that it’s unlikely that Medicare will continue to make it only an upside-risk program beyond three years. So we will be entering into a Medicare advantage plan of our own beginning in January 2014. And we will be managing a population for which we have the full continuum of risk, but not through the MSSP program under Medicare. It will also allow the system and our IPA to then enter into other types of gainsharing and accountable care contracting on the private side as well.
You’ll be well set in terms of doing readmissions reduction work, I think.
Well, that’s what we’re hoping for. When I came to Atlanta five years ago, this market was highly fragmented and did not have the basis for population management work. So it’s taken five years to get this set up; so we’re a little behind some other systems, but we’re getting our capacity to do that in place, in the next 12 to 18 months. We should be able to go live on the utilization analytics by 1/1/14. This market is not quite ready for that yet. In fact, when I started to talk with the local health plans about my plans for this work, they weren’t ready themselves. This market really blew apart into a cottage industry years ago, and only within the past four years has it begun moving in the direction of accountable care.
What key lessons have you and your colleagues learned so far?
The first thing I learned, and I knew this before, was that it’s not just about the IT systems themselves. It’s about governance; and it’s about how you get the physicians’ trust in working with these systems. So you need the governance systems to build that trust. It’s not just about having a machine; it’s about being able to govern the information. Second, it’s about progressive use of the data that you’re giving to the physicians. And every market is a little bit different in what physicians can take initially. It’s about being able to build something in a manner that physicians can trust, so that the data is reliable and accurate and can be used in a manner that can affect care. It’s quite energizing for physicians to see improvement in areas that they could not previously see. And the third is to find a platform you can use, so that whatever system you buy can grow with your needs. Sometimes, people go out and buy the top of the line, and the physicians say, I don’t even know where to start. So sometimes, it helps to be able to know what you need at the moment, but also to get a system that can grow with you as you’re capable of expanding.