A year-old coalition of Wisconsin healthcare providers and employers formed to publicly report clinical and patient satisfaction data has more than doubled in size with the addition of 11 new provider groups, and the group has eyes on expanding membership throughout the state.
"Madison is pretty well blanketed," said Jeff Thompson, M.D., chief executive officer of 320-bed Gunderson Lutheran in LaCrosse, Wis., one of nine original member of the not-for-profit Wisconsin Collaborative for Healthcare Quality.
"I would say once all these new organizations get in, we'll have anywhere between 35 to 40% of the physicians and probably the same percentage of beds," Thompson said.
Thompson said the coalition is poised to grow even more.
"We made a judgement to keep it small so we can get off to a fast start," he said. "Now, we're trying to be very inclusive. We said we'd take everybody, with the only qualification that they come in with an open mind and are willing to pay for what it costs for (their) information."
A full list of the provider and employer member organizations is posted at the Web site of the collaborative, wchq.org. Data from the nine founders from 2002 and 2003 is available on the Web site.
The group collects data on 42 measures in a dozen performance categories, including the usual quality-improvement areas such as congestive heart failure, diabetes management and patient satisfaction, as well as the three initial Leapfrog Group measures, computerized physician order entry, evidence-based referrals and intensivist staffing in intensive-care units.
An unusual, if not unique, area of reporting undertaken by the group is physician access.
"We took on some areas the business community said they wanted to see," Thompson said. He said employers would ask, " 'What about when my employee has a bad back, how long does it take my employee to get in and see a doc? That's a big deal for me.' So, we said, okay, we'll take on access."
The results, expressed in days or fractions thereof that it takes a patient to get an appointment to see a physician, are broken down into two categories: long appointments for annual physicals, new patients and complex or chronic problems; and short appointments, which include acute-care problems and follow-up visits.
"It was a big struggle to get common definitions," he said. "Here's an example: If you call in Thursday and they say I can get you in Tuesday, do you count Saturday and Sunday or do you count business days?"
The group agreed a fair way of measuring was to count business days, excluding Saturdays and Sundays.
Thompson said an ongoing, but thus far unsuccessful, state effort to collect and publish data and the general collegiality of some top physician leaders provided impetus for forming the coalition.
"A group of us, mostly physician CEOs and CMOs of big groups and hospitals, got together and said we believe we have pretty good care in Wisconsin, the data would show that, but there would be an advantage with going public with our data. We believe it's going to happen anyway, so we wanted to get out in front of it," Thompson said.
The physician leaders also believed they could respond to the concerns of the business community and wanted to bring them under the same tent. Disclosure to them would be essential.
"Rising costs are a big problem, but we really have to look at value," Thompson said. "We have to look at an episode of care. We said getting our business partners involved would help so we wouldn't have an adversarial relationship.
"We felt by going public it would be another tool in our toolbox to drive internal change. We'd let people know we know we're not perfect. And if we don't improve, we know we're going to get gunned and we should."
Data from all 20 providers for 2003 is currently under audit by MetaStar, the Wisconsin Medicare quality-improvement organization, or QIO, which has a contract with the collaborative to analyze and validate each provider's submissions.
Deborah Unger, executive director of the coalition, said hiring the QIO gives the effort an arm's-length review so that "everyone who has access to that data will have assurance it's an apples-to-apples comparison."
The audit process will take until December, Unger said. The QIO will report it back to the group for review, then it will be sent to the Web vendor for public posting sometime in January, she said.
Thus far, the data is not being used in any pay-for-performance scheme, Thompson said.
"Those discussions have occurred, but most people feel to have meaningful pay for performance, the data needs to get a little bit better. But that hasn't been the focus of this group.
"Strategically, do I think this will position us well if, outside of us, (someone) develops a pay-for-performance plan."
Cheryl DeMars is director of quality for the Employer Health Care Alliance Cooperative, a 160-employer healthcare coalition based in Madison, Wis., whose members provide healthcare coverage for 95,000 employees and family members in 13 counties in south central Wisconsin.
"What the collaborative has is a good start," DeMars said. "We're looking forward to that expanding to include measures of economic efficiency. Employers need to see both cost and quality to achieve the goal of value-based purchasing.
"We're working on launching a pilot for performance-based reimbursements," she said. "We're negotiating some contracts with several pilot hospitals right now. We want to not only reward quality providers but also eliminate some of the disincentives to providing quality of care."
One example is with Caesarean sections, DeMars said.
"Physicians and hospitals fare much better (financially) if they deliver a baby by C-section," she said. "We've seen the C-section rate climb over the last several years for several reasons, but it doesn't help that we have incentives aligned incorrectly."
DeMars also said the employers want to see performance data developed at the physician level. "Because the coalition involves physician groups, it may be the best way to get at that data," she said.
Thompson said physician leaders in other states contemplating involvement in public reporting projects should step out boldly.
"My advice is, first of all, it's worth the effort," Thompson said. "You'll get good response from your businesses, legislature and patients by being more transparent, by going out in public."
Second, Thompson said, as much as possible, use data that's already defined and electronically collected.
"We tried to be as consistent as we can with national reporting as much as we can so we decrease the amount of duplicative work," he said.
Finally, don't sweat the objections of fellow physicians about putting their collective data out on Front Street.
"There was a little stewing, but it turned out to not be a big deal," Thompson said.
