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KEY POINTS
CMS launched Physician Compare in December of 2010, and it expanded to include information on the quality of physicians’ care in 2013. Measuring and reporting on the performance of doctors represents an effort to move to a more transparent healthcare system.
The strategy the IOM recommended to improve quality of care was to pay for performance (P4P) or financial incentives to transform behaviors to achieve greater value.
Process measures are more highly sensitive to differences in the quality of care and are easier to interpret. However, a process measure is only of value if it is assumed to have a link to a meaningful outcome. By itself, it has little intrinsic value.
One advantage of outcome measurement, for example, mortality rate, is that it is a measure that is important on its own, even if the differences have nothing to do with the quality of care.
One of the main issues of measuring intensivist performance is physician attribution. Each episode of care would involve multiple intensivists and other physicians.
Using ICU LOS as a process measure would discourage intensivists from providing time-consuming, yet important, end-of-life care for ICU patients, leading to more fragmentation of care.
Even though risk adjustment applies, using hospital mortality as a quality-outcome measure would not account for the impact of palliative care and the ability to transfer to LTACs.
The current system has not yet been made to link the fragmented entities caring for these patients with critical illnesses around accountability for value.
To improve service productivity, measuring and monitoring performance and its variance is a fundamental requirement for identifying efficiencies and best practices and for spreading them throughout the system or organization.
Advancing performance measurement at the physician level is the vital strategy on the policy agenda when considerable unexplained variation exists in practices that lead to poor quality, inefficient care delivery, and waste of resources.
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The US health system is the most expensive system in the world, and yet numerous developing countries outperform us.1 Patients with critical illnesses account for the majority of healthcare expenditures per capita. According to a 2009 study by the Medicare Payment Advisory Commission (MedPAC), the top 5% of spenders account for 50% of all healthcare spending, totaling $623 billion, or nearly $41,000 per patient.2 Since the population is aging and medical technology is advancing, this group of patients is growing rapidly. Managing patients with critical illnesses presents considerable challenges: high-cost care, frequent readmissions, and dissatisfaction of care among them.3
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ICU care is labor- and resource-intensive. The focus on quality performance and maintaining quality processes is vital to critical care. In the United States, the major players monitoring ICU quality performance include the Agency for Healthcare Research and Quality, the National Quality Forum (NQF), the Volunteer Hospital Association, the Institute for Healthcare Improvement, the Leapfrog Group, and the Joint Commission. In 2010, the NQF endorsed ...