Everyone’s Keeping Score These Days
Rahul K. Shah, MD, George Washington University School of Medicine, Children’s National Medical Center, Washington, DC The use of metrics has long been a part of business culture. Certainly, hospitals have similarly utilized scorecards to measure such metrics as their financial operations and their efficiency with intra-hospital and peer comparisons. Recently, scorecards have started being rolled out or mandated to measure quality improvement as well as physicians’ outcomes. Many hospitals have quality improvement dashboards or scorecards. These are kept at a high level and usually do not report on individual physician outcomes. However, as mandated by the Joint Commission, the Ongoing Professional Practice Evaluation (OPPE) is ultimately a physician scorecard. Medical staffs have the freedom to design these with certain elements that are compulsory categories, such as attempting to follow the ACGME’s six core competencies. The role of these physician performance scorecards, as envisioned by the regulatory agencies, is to be able to instantly compare physicians within departments and intra-hospital as well as between different hospitals. This will produce an estimation of the clinical care delivered by the physician and a comprehensive review of their outcomes. Imagine in our current state that a hospital can really only know about a physician’s performance at their hospital. If a physician is having poor outcomes or taking sicker/higher risk patients to another institution (for whatever reasons), it may not be noticed by the other hospitals. We can consider that as the power of technology grows and the ability to aggregate such data becomes rapid and easy, these scorecards will become extremely sophisticated. Currently, many hospitals and medical staffs are struggling with rolling out the OPPE as the beta version or the initial live version. The Joint Commission mandates that the OPPE is conducted twice a year; so in the next year and a half, most medical staffs will be moving on to OPPE version three or four! The sophistication of these scorecards and thus, their inherent utility will become quite apparent. Furthermore, the physician scorecards provide much needed data to department chairs and administrators regarding trends in physician performance, outcomes, and case volumes. A Focused Professional Practice Evaluation (FPPE), which is an analysis of a recent outcome or areas of concern for a physician, can be more easily performed with the setting of robust scorecards. In this column, we often speak about metrics that matter with respect to how we as otolaryngologists define metrics that track our own outcomes. The onus of the Joint Commission OPPE is that the burden rests on us to ensure that the metrics we are describing and setting up are consistent, measurable, and actionable. As OPPE and scorecards evolve, the strength of the defined metrics will grow and the need to not only define strong specialty-specific metrics, but also global metrics (those not specialty-specific) will grow. A crucial aspect of scorecards is their ability to provide hospital administrators and department chiefs with instant ability to analyze their providers for potential over-use measures. This is an area with significant exposure risk for surgeons. There have been high-profile, multi-million dollar settlements with hospitals based on surgeons’ over-use of specific procedures. An outcomes scorecard may not have prevented this from occurring, but such procedural bias or significant deviance from the averages in a hospital or department may have been much more apparent in the setting of a six-month cycled OPPE or scorecard. We anticipate in the coming years that outcome scorecards for physicians to demonstrate and measure the quality of care they deliver will emerge as a real force for medical staffs and will certainly be a tool to help us improve and show the quality of care that we deliver. We encourage members to write us with any topic of interest, and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.
Rahul K. Shah, MD, George Washington University School of Medicine, Children’s National Medical Center, Washington, DC
The use of metrics has long been a part of business culture. Certainly, hospitals have similarly utilized scorecards to measure such metrics as their financial operations and their efficiency with intra-hospital and peer comparisons. Recently, scorecards have started being rolled out or mandated to measure quality improvement as well as physicians’ outcomes. Many hospitals have quality improvement dashboards or scorecards. These are kept at a high level and usually do not report on individual physician outcomes.
However, as mandated by the Joint Commission, the Ongoing Professional Practice Evaluation (OPPE) is ultimately a physician scorecard. Medical staffs have the freedom to design these with certain elements that are compulsory categories, such as attempting to follow the ACGME’s six core competencies.
The role of these physician performance scorecards, as envisioned by the regulatory agencies, is to be able to instantly compare physicians within departments and intra-hospital as well as between different hospitals. This will produce an estimation of the clinical care delivered by the physician and a comprehensive review of their outcomes. Imagine in our current state that a hospital can really only know about a physician’s performance at their hospital. If a physician is having poor outcomes or taking sicker/higher risk patients to another institution (for whatever reasons), it may not be noticed by the other hospitals.
We can consider that as the power of technology grows and the ability to aggregate such data becomes rapid and easy, these scorecards will become extremely sophisticated. Currently, many hospitals and medical staffs are struggling with rolling out the OPPE as the beta version or the initial live version. The Joint Commission mandates that the OPPE is conducted twice a year; so in the next year and a half, most medical staffs will be moving on to OPPE version three or four! The sophistication of these scorecards and thus, their inherent utility will become quite apparent.
Furthermore, the physician scorecards provide much needed data to department chairs and administrators regarding trends in physician performance, outcomes, and case volumes. A Focused Professional Practice Evaluation (FPPE), which is an analysis of a recent outcome or areas of concern for a physician, can be more easily performed with the setting of robust scorecards.
In this column, we often speak about metrics that matter with respect to how we as otolaryngologists define metrics that track our own outcomes. The onus of the Joint Commission OPPE is that the burden rests on us to ensure that the metrics we are describing and setting up are consistent, measurable, and actionable. As OPPE and scorecards evolve, the strength of the defined metrics will grow and the need to not only define strong specialty-specific metrics, but also global metrics (those not specialty-specific) will grow.
A crucial aspect of scorecards is their ability to provide hospital administrators and department chiefs with instant ability to analyze their providers for potential over-use measures. This is an area with significant exposure risk for surgeons. There have been high-profile, multi-million dollar settlements with hospitals based on surgeons’ over-use of specific procedures. An outcomes scorecard may not have prevented this from occurring, but such procedural bias or significant deviance from the averages in a hospital or department may have been much more apparent in the setting of a six-month cycled OPPE or scorecard.
We anticipate in the coming years that outcome scorecards for physicians to demonstrate and measure the quality of care they deliver will emerge as a real force for medical staffs and will certainly be a tool to help us improve and show the quality of care that we deliver.
We encourage members to write us with any topic of interest, and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.