Hospitals tend to measure the quality of their hospitalist physicians as a group rather than assigning quality measures to individuals. During a Dec. 11 presentation at Johns Hopkins School of Medicine Division of Health Science Informatics, Daniel Brotman, M.D., described an effort there to change that.
“There are quality concerns unique to hospitalists and how we feed data back to hospitalists. Metric attribution at the provider level is challenging but not impossible if you know who saw which patient when,” said Brotman, director of the hospitalist program at the Johns Hopkins Hospital in Baltimore.
If you are assessing the quality of a surgery, Brotman said, it might make sense to assign all the quality measures to the physician who performed the surgery. But during a hospital stay, three hospitalists might see a patient and it would be problematic to assign the first doctor they saw responsibility for the whole hospitalization.
With help from data specialists and members of the hospitalist team, Brotman created a real-time provider-level dashboard that assigns responsibility for quality measures to individual physicians. The measures include things like venous thromboembolism prophylaxis, discharge summary turnaround time, time of discharge, communication with the primary care provider and patient satisfaction scores. The dashboard distributed credit or blame to providers proportional to how many days they saw the patient. “This is possible to do with EHRs,” Brotman said, “but right now we are using a variety of data sources including billing data.”
Johns Hopkins has been able to tie annual bonuses to performance on these measures. And they have been able to see improvements in several areas with use of the dashboard and pay-for-performance bonuses. With VTE prophylaxis rates, for instance, a study found that feedback using the dashboard was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program.
But some measures have not changed favorably since the introduction of the dashboard, Brotman said. One argument they hear is that some measures are a team effort that individual physicians can’t impact by themself. He said if there are issues about things like time of day of discharge that are impacted by nursing issues, those are systems issues to think collectively about in terms of systems improvements.