Bacon's Rebellion

Democracy Thrives in Sunlight

Virginia Docs Ramp up Quality Initiative

—

by

James A. Bacon
in

An initiative backed by HCA Virginia hopes to improve patient care by getting physicians to open up their medical decisions and practices to the scrutiny of other doctors. The Virginia Quality Care Partnership will identify best practices and measure physicians performance against those standards.

The collaboration started with about 30 doctors and is expected to grow quickly to 200 or 300, reports Tammie Smith with the Times-Dispatch. The initiative covers 37 medical specialties. The program, which is open to all comers, is voluntary.

“It’s doctors getting together, deciding what are the important things to measure and do to improve quality, and holding ourselves accountable for meeting those standards,” says Dr. Glenn Glessel, a lung specialist who is chairing the new organization. There is no charge for participating. “What the doctors are providing is sweat equity, if you will. They are putting in time to develop the measures and review performance.”

The movement to measure physician performance and hold them accountable is gaining momentum. VCU Medical Center, Virginia’s largest hospital, recently kicked off a similar program called RAM care, standing for reliable, accurate and measurable care. The data is used in “report cards” used in evaluating the doctors.

Bacon’s bottom line: My question is, what’s taken so long? If physicians and health care systems don’t adopt best practices and measure performance, pretty basic stuff in other industries, they invite the federal government, which has a twitchy regulatory finger as it is, to intercede. If you were a doctor, who would you rather have overseeing your performance — Congress and a bunch of federal bureaucrats, or your professional colleagues?

Escalating health care costs are undermining the economy and the fiscal sustainability of state and local government. The only way to ward off disaster without debilitating cuts to services is to unleash the same kind of innovation and productivity gains seen in other sectors of the U.S. economy. This looks like a small step in the right direction. But we need a lot more where this came from.

— JAB

Special thanks to DUI attorney Vanessa Hicks for supporting Bacon’s Rebellion.

Share this article

ADVERTISEMENT

(comments below)

ADVERTISEMENT

(comments below)

Comments

  1. larryg Avatar
    larryg

    here’s the sleeper than many are missing:

    Medicare and Medicaid Electronic Health Record (EHR) Incentive Payment Programs

    1. DJRippert Avatar
      DJRippert

      The “sleeper” is well known to doctors, at least to mine. However, the funds for automation are a big step forward in getting doctors to be able to share information.

      However, all is not necessarily well in EMR – land. Proprietary data models and systems are potentially creating “islands of medical information”. The following article from Forbes does a good job of explaining the current situation:

      http://www.forbes.com/sites/davidshaywitz/2012/06/09/epic-challenge-what-the-emergence-of-an-emr-giant-means-for-the-future-of-healthcare-innovation/

      Should the government demand open standards for health records? Given that Obamacare is based on a tax it seems fair to me that government guarantee interoperability of the data by demanding open standards.

  2. larryg Avatar
    larryg

    You know the really FUNNY THING! The govt ALREADY has such a system – it’s called the Military and VA health care system!

    re: proprietary data models

    we went through this with software and hardware – I’m quite sure you are intimately familiar and then the companies that were truly interested in solutions adopted open-systems approaches (except for Apple of course).

    I think the govt should REQUIRE interoperability standards – as they have done with Medicare and MedicAid…

    When you hit the ER in Cleveland – unconscious – the docs should be able to do the best job they can to save your life by accessing your medical history instead of running dozens of tests that take time and money before they know how to proceed.

    if you had an electronic medical record, you would own it and you could then “shop around” for whatever kind of medical care you were interested in and providers would be forced to confront quality and price – at least more than they do right now.

    But you know if we did that – the right wing would scream bloody murder about that nasty old govt involvement in what ought to be a free market.

    1. Darrell Avatar
      Darrell

      Well my medical record isn’t so easy to share. I have records at the main military hospital, more at two civilian hospitals. Then there are the different doctors who don’t seem to be aware of each other. I go to one doctor and he writes a Px, which is changed to something else by the next doctor I see. Back and forth, an endless line of paper scattered all over the region. Military medicine never seems to consolidate the treatment, especially when outside commercial interests are involved. The whole thing just seems to fall apart once you get a referral.

  3. Peter Galuszka Avatar
    Peter Galuszka

    So let me see if I get this right..

    Doctors have never shared notes before or had peer review. Not quite. There are medical associations, speciality associations, peer review on hospital mortalities, census, and the list goes on and on and on as it has for years.

    HCA is leading the charge? Let’s see. That’s HCA, the Nashville-based hospital-owning, for-profit medical goliath that has been buying up individual doctors’ practices left and right. Does HCA review the performance of the practices it owns directly? Or is it offering its sheltering and comforting arm to independent practices it dos not own?

    Then there’s the always-fun argument that if pro-profit health firms don’t do this, the Big Bad Government will swoop in and make everyone’s lives miserable. To some extent, it has, for years. Maybe Bacon is trying to blame Obamacare here in some obscure way. Fact is, one of the problems with Obamacare is that it is designed to keep big for-profit firms like HCA in business, ditto self-serving insurance firms .
    Doctors can’t exactly run amok these days with managed care denying everything so the commercial insurers can make money. If they are dangerous and incompetent, there are ways to deal with them.

    Self-policying physicians has been around for many years (and may be a problem in itself). For Jim Bacon to imply that this is a new idea hatched by HCA shows a fundamental and huge lack of understanding of how the real world of health care works. My strong suggestion is that he stop recycling press releases and Cato white papers and get into an ER or a doctor’s office to see for himself.

    1. James A. Bacon Avatar
      James A. Bacon

      Peter, you heap one supposition upon another. I haven’t implied a single thing that you say I did. Of course physicians have “policed” themselves for a long time — but only for the most grievous lapses in medical care. People have been talking about sharing and promoting best practices for a long time, but the industry has been incredibly slow to translate act into theory. This new initiative is a step forward…. a small step forward, as I said in my post.

      Don’t get too full of yourself. Visiting a doctor’s office for an article in Style doesn’t make you an authority. I’ve spent a fair amount of time in this space myself — and what I’ve learned hasn’t come from Cato white papers!

  4. larryg Avatar
    larryg

    Darrell – I was under the impression that for your military records – that they would be available no matter where you sought care in the military system.

    no?

    your stats on the VA do not really surprise me – VA care is not convenient.

    Down my way the veterans have a Van and several times a week Veterans catch a ride to Richmond to the VA hospital.

Leave a Reply

Read More