Across the past five years, Memorial Hermann Healthcare System in Houston has implemented a successful initiative to reduce practice variability and improve physician performance. The adoption of a physician performance data analysis platform was critical to the positive outcomes of this initiative. The platform provides medical leadership with accurate, detailed, comparable, and trusted data to serve as the basis for an ongoing structured dialogue with individual physicians aimed at improving their performance in key metrics.
Within a year of implementing the system, physicians in the initiative demonstrated quantifiable improvements across numerous critical measures of patient quality, including rates of complications, readmissions, and Joint Commission core measure compliance. In addition, the group achieved improvements in utilization measures such as cost and average length of stay. In the first year alone, Memorial Hermanns savings were an estimated $3.7 million, or $358 per patient admission.
Before the initiative, our medical leadership faced the challenge of surfacing and addressing deviations in physician practice patterns quickly enough to be able to influence physician behavior. Traditional reporting methods were time consuming, labor intensive, and prone to error, impeding productive collaboration. Medical leadership required a means of sharing performance data in an interactive and dynamic manner, a tool with the flexibility to drill down to case-level detail as necessary to address physician concerns about the data or conclusions relating to their performance.
We chose to implement single platform leveraging physician performance data analysis platform because it has the ability to generate detailed physician profiles that encompass quality performance, adherence to predefined order sets, and resource utilization. The platform leverages pre-existing data to automatically create visually compelling profiles for individual physicians, departments, and groups. It compares performance levels to severity-adjusted peers and measures compliance to specific goals and best practices.
In addition, the platform offered Memorial Hermann significant advantages in both ease of implementation and cost, as no hardware purchase is required. Licensing costs to maintain and support this platform on a yearly basis is $200 per bed, based upon a 3,500-bed health system. The time spent to maintain and support this platform is .125 full-time employees, which is offset by efficiency gains, ultimately resulting in savings.
The physician performance data analysis platform was a critical starting point for a broader performance improvement initiative, serving as the key tool for quarterly meetings with individual physicians to review performance data and discuss improvement recommendations. While some physicians were initially skeptical, responses changed as they were able to drill down to the underlying data to verify that it was both accurate and severity-adjusted. The quarterly meetings soon became a productive forum for discussing such key quality metrics as readmissions, mortality, complications, and Joint Commission core measures, as well as utilization data such as length of stay, avoidable days, denials, and charges. Physicians, fully engaged in the process, now pose questions like Why was this data not available to me earlier? and What can I do to improve in this area?
Rigorous performance analysis was undertaken, comparing physician performance both to a full year of pre-initiative data and also to severity-adjusted data from a control group.
The first year results are striking:
- Compliance to core measures improved by 10.5%
- Readmissions decreased by 9.8%
- Complications decreased by 14.2%
- Mortality rate decreased by 16.3%
This initiative demonstrates the power of data-driven conversations to enhance quality while at the same time decreasing costs. Memorial Hermanns savings for the first year of the initiative alone is estimated at $3.7 million, or $358 per patient admission.
We believe that Memorial Hermanns physician performance improvement initiative prepares us to benefit from the American Recovery and Reinvestment Act of 2009s Medicare and Medicaid incentive payments set to commence in 2011 for institutions making meaningful use of healthcare information technology. While the term meaningful use has yet to be defined, it is clear that the final regulation will require more of providers than merely the installation of an EHR; providers will need to demonstrate use of the technology to create data-driven performance improvements in both quality and cost measures. Over time, as more providers implement electronic medical records, more comprehensive clinical data sets will be available and the ability to accurately measure quality, resource utilization and costs will increase. These types of performance measures will help demonstrate the extent to which payments for health IT use are actually facilitating improvements in the healthcare system – a critical measure of meaningful use.
In that context, we are prepared to demonstrate how our initiative leveraging the physician performance data analysis platform has been valuable in changing physician behavior via objective measures of outcomes and performance. Further, we believe that our competency in this arena will not only be essential in proving meaningful for the incentive payments but will also be a critical success factor in a reformed healthcare environment where more accountability for performance will likely be embedded within the payment system.
David BradshawCIO Memorial Hermann Healthcare System Houston