Measuring Physician Performance

Rahul K. Shah, MD George Washington University School of Medicine Children’s National Medical Center, Washington, DC We often use this column to speak about patient safety and quality improvement topics that are on the horizon or currently en vogue. One item that is mentioned a lot is the need for measurement. This goes back to the basic business adage that one cannot manage what one cannot measure. Indeed, the patient safety and quality improvement movement has had significant gains and victories in the past decade founded on a strong methodology that includes measurement. This measurement and evaluations has also started to come to providers. The Joint Commission has a mandatory evaluation tool for providers (physicians, LIPs, etc.) called the On-going Professional Performance Evaluation. Hopefully, every Academy member is aware that the hospitals in which they practice are required to complete an OPPE report on each medical staff member (physician, physician assistant, nurse practitioner, etc.) three times in a two-year cycle. The OPPEs were a relatively new concept a decade ago, however I am quite certain that in the past two-year cycle, every Academy member whom has active privileges should have had an OPPE report on file at their respective medical staff office. The more important question is—have you seen your OPPE report? Measurement by and of itself may be adequate, but it is compulsory for us to know what is being measured. There is latitude afforded to the individual medical staff offices on how they create the OPPE, what is measured, and the action items from the reports. This freedom allows each medical staff office the ability to customize reports and drive initiatives/change in areas where they feel they would like to focus upon to improve patient safety and quality. For example, a medical staff office may want to focus on hand hygiene compliance, surgical site infections, or re-admission rates. The point being is that Academy members should be aware that such information is collected and maintained by your medical staff office. What started, perhaps, as a fluff document that a medical staff office would fill out to ensure compliance with the Joint Commission is slowly emerging as a powerful tool with some excellent best practices; the OPPE is increasingly being used for credentialing and in a robust manner. For example, I have heard of some institutions that look at an OPPE to see if there is “over-operation”for specific procedures or diagnoses; or the contrary, if a provider has not performed a specific case in more than two years, they may be denied privileging for that case. As such, it is compulsory that we own our data. Academy members must be pro-active and reach out to your various medical staffs in the hospitals you practice at to obtain your OPPE report. Traditionally, the Joint Commission recommends that the OPPE report have structure; our organization uses the core competencies such as professionalism, systems-based practice, etc.  From here, the recommendation is to have a few key metrics under each category that is provider specific. Examples would be patient satisfaction scores, incomplete operative dictations, etc. What is interesting, an emerging best practice is to list the top five procedures of the specific provider. This enables a chief of staff to immediately scan similar providers to look for variances and outliers. Such scrutiny and transparency will only serve to benefit our patients so we applaud the OPPE. The caution to our Academy membership is take a few minutes from your busy days and drop by your respective medial staff office and asks to see your OPPE and make sure that the data is accurate and reflects your practice and volumes. 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.