Thomas R McLean, MD, JD, FACS, ESQ.

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Presentation transcript:

Reporting and Motivating Performance: Reputational Incentives Created by Report Cards Thomas R McLean, MD, JD, FACS, ESQ. CEO, Third Millennium Consultants, LLC Attending Surgeon, Eastern Kansas VA Health Care System tmclean@dnamail.com

Disclaimer & Disclosures Nothing in this talk is be considered VA policy procedure, or Recommendations I have no financial interests in the material presented.

Thank You Integrated Healthcare Association Ms. Cindy Ernst

Report Cards & Reputational Incentives http://company.ipro.org/pix/P4P.png

Report Cards & Reputational Incentives Why shift to VBP? At the time, MDs failed to follow evidence-based medicine practices 55% of the time. Estimated that 30-40% Medicare expenditures were waste. Elizabeth A McGlynn, Steven M. Asch, John Adams, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine, June 26, 2003; http://content.nejm.org/cgi/content/full/348/26/2635 (29 Dec 08); Arthur A. Levin, “Medicare Turns 40,” Center for Medicare Consumers, August 2005 (29 Dec 08); http://www.wasteofadollar.com/dollar_in_toilet.jpg

Report Cards & Reputational Incentives VBP Carrot: P4P Stick: the government should “encourage the adoption of best practices through the release of public domain comparative quality data.” Translation: Provider-specific report cards Leadership by Example, p 56; http://company.ipro.org/pix/P4P.png http://www.ffitz.com/ff/main/graphic2/icarrot.gif

Report Cards & Reputational Incentives Public dissemination The private handling of adverse outcomes “works best in circumstances where the public has a high degree of trust in [the reviewing] institutions.” Public trust is at a minimum Managed care Ineffectiveness of peer review Daily newspaper stories of provider incompetence Steven Clarke and Justin Oakley: Informed Consent and Clinician Accountability: The Ethics of Report Cards on Surgeon Perfomance, Cambridge 2008. http://blog.evidenceinmotion.com/photos/uncategorized/2008/06/25/reportcard.gif

Report Cards & Reputational Incentives Primary purpose of report cards is to influence behavior. Report Cards should reward good performance “remove” poor performers Therefore, report cards create reputational incentives for providers Inst. of Med.: Rewarding Provider Performance. NAS Press, Washington DC (2007); Wicks EK and Meyer JA: Making Report Cards Work. Health Affairs 1999; 18(2):152-6; Wicks, EW; Meyer, JA. Making Report Cards Work. Health Affairs. 1999;18:152–155; Palmer, RH. Securing Health Care Quality for Medicare. Health Affairs. 1995;14: 89–100.

Report Cards & Reputational Incentives Provider report cards are new a new idea: Mesopotamia 1850’s Florence Nightingale 1900’s Earnest Codmen 1980’s NYS collects cardiac services outcomes data Web-based provider-specific outcomes data