Dealing with emerging trends toward measuring physician efficiency and developing performance measures for primary-care patient safety were two ideas that generated plenty of discussion at the Physician Consortium for Performance Improvement's June 3 meeting in Rosemont, Ill.
The consortium was formed by the American Medical Association and staffed by AMA employees. It includes representatives from 65 national medical specialty societies, eight state medical associations and two federal health agencies. Its mission is to develop performance measures "by physicians, for physicians," and the idea that payers or other nonmedical organizations may soon impose efficiency measures on doctors was a notion that many in attendance found grating.
In particular, consortium participants criticized the use of ETGs, or "episode treatment groups," to rate a physician's efficiency, saying they're based on "dirty" methodology. Presenter Thomas Lee, M.D., network president for Partners HealthCare System in Massachusetts, gave ETGs a lukewarm compliment when he compared them to the Scholastic Aptitude Test, which he described as "far from perfect, but directionally correct."
But Lee added that ETGs, which classify an entire episode of care, do not take into account that "medicine is a team sport today," and that leads to uncertainty over which individual physician should receive attribution for the costs or outcomes of a particular treatment episode.
Nevertheless, Lee -- who is also an associate editor for the New England Journal of Medicine -- warned the physicians that trying to obstruct the development and implementation of efficiency measures would probably backfire. Instead, he recommended that the consortium help define the principles about how the measures would be used.
"Saying something is unacceptable takes you out of the discussion," he said, adding that deferring action until perfect measures become available is not a viable strategy.
The common definition of healthcare quality improvement involves reducing the underuse, overuse or misuse of medical treatments. Lee urged physician leaders concerned with efficiency measures to make reduction of overuse a priority, noting more than once that "overuse is bad medicine."
Though not as controversial, the primary-care patient safety presentations also generated much interest. Meeting materials stated that the topic was included in the program as part of an "initial exploration" of approaches the consortium may wish to consider taking on the subject.
Speaker Jennifer Daley, M.D., senior vice president of clinical quality and chief medical officer for Tenet Healthcare Corp., Dallas, noted that patient safety mishaps in the ambulatory-care setting setting are rare and therefore difficult for statisticians to measure. She suggested that, by defining patient safety as mitigating harm or "not having any defects," it would make it easier for nonmedical staff to better understand what is trying to be accomplished.
Another presenter, Nancy Elder, M.D., a University of Cincinnati Department of Family Medicine associate professor, highlighted how the bulk of patient safety research has been done in hospitals despite the fact that the vast majority of healthcare services are delivered in ambulatory settings.
If the consortium were to develop performance measures for primary-care patient safety, Elder recommended that it start with medication safety, diagnostic test processing and charting procedures.