1. 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

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

3. Thank You
Integrated Healthcare Association
Ms. Cindy Ernst

4. Report Cards & Reputational Incentives

5. 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; (29 Dec 08); Arthur A. Levin, “Medicare Turns 40,” Center for Medicare Consumers, August 2005 (29 Dec 08);

6. 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;

7. 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.

8. 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.

9. 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