When patients visit Dr. Judy Baumhauer in hopes of getting rid of bunions—a painful, bony bump that develops at the base of the big toe—they often have just one question: Will surgery help?
The answer varies from patient to patient, said Baumhauer, an orthopedic surgeon at the University of Rochester (N.Y.) Medical Center. A highly useful tool for determining the most effective treatment is a patient survey from Promis, or Patient-Reported Outcomes Measurement Information System, composed of questions about the patient's quality of life and ability to function.
“I listen to their concerns about their bunion, we look at X-rays together, and then we look at their Promis scores,” said Baumhauer, who has researched the tool extensively and sits on the board of directors for the Promis Health Organization. If the Promis results show a patient is functioning well, then surgery is unlikely to help. That knowledge allows her to confidently tell a patient that nonsurgical treatment is the best option.
Physicians, policymakers and payers in healthcare are increasingly asking patients for their input. This information is viewed as vital for clinicians, payers and health systems as the industry transitions from fee-for-service to value-based payment. By shaping clinical decisions and helping gauge the benefit of medical care, the patient's perception of health before and after treatment is critical not only for maximizing the quality of care but also for assessing its value, many in the industry say.
But the science and technical infrastructure to capture this information and incorporate it into payment programs fall short of the eagerness and optimism for using them. At this frontier of quality measurement, important questions remain over how these metrics can be implemented, what burden they'll impose on physicians and patients, and how they'll be used to determine payment.
The National Institutes of Health said this past October it would pour $6.3 million into an initiative to integrate these tools into electronic health record systems, including those by Epic Systems Corp. and Cerner Corp. Patient-reported outcomes measures are not readily compatible with these systems, a technological challenge that frustrates many.
“It's a very, very active space,” said Helen Burstin, chief scientific officer for the National Quality Forum, the Washington, D.C.-based body that reviews and endorses quality measures using a consensus-based process. “The real challenge is thinking about how that data starts to get used in clinical practice.”
In December, the NQF held its annual meetings of clinicians, hospital leaders and others to discuss performance measures under consideration by the CMS for use in the coming fiscal year. From those meetings emerged “an incredible amount of excitement about how this seems so much more important and relevant—to have the voice of the patient being measured,” Burstin said.