January / February 2006
NEWS ITEMS FROM SOURCES WORLDWIDE
Pulse
Physicians' Skeptical About Measurement Programs
A survey of physicians by the Massachusetts Medical Society shows that an overwhelming majority of physicians in the state remain skeptical or unsure about the accuracy and usefulness of programs now being developed that measure the cost effectiveness and quality of healthcare.
Such measurement programs — called "transparency" efforts within healthcare — are being proposed by many health insurers as a way to control spiraling healthcare costs. The premise behind such measurements is that if patients know more about the cost and quality of healthcare as offered by different providers, they will make better decisions on healthcare purchasing, thereby reducing healthcare costs overall.Ý
The Medical Society's survey, however, raises questions about how much physicians trust the data being collected and compiled, whether such information will have enough meaning to patients to effect the desired changes of lowering costs, and whether the data will provide a true picture of the quality of care between physician and patient. Many of the measurements now being taken are based largely on prior years' claims data by health insurers.Ý
When asked about the accuracy of quality measures that payers are using to rate physicians, a combined 65.5% of physicians responding to the survey said they were not accurate (42.9%) or only somewhat accurate (22.6%). An additional 30.5% said they didn't know.
For example, when asked about the accuracy of cost measures that payers are using for physicians, a combined 56.6% said they were not accurate (35.9%) or only somewhat accurate (20.7%). An even greater percentage (39.7%) said they didn't know.Ý
Similar responses came from questions about the usefulness of quality and cost measures for quality improvement initiatives for physicians.
As to the usefulness of the quality measures being used for physicians, a combined 58.5% said they are not useful (30.6%) or only somewhat useful (27.9%). More than one-third (33.6%) said they didn't know. As to the usefulness of cost measures, 56.2% said they were not useful (35.6%) or only somewhat useful (20.6%). Again, more than one-third (37.8%) said they didn't know.
When physicians were asked about the accuracy and usefulness of the measures used to rate hospitals and nursing homes, they answered with similar responses, with an even higher percentage of "don't knows."
The high percentage of "don't know" answers may well reflect the physicians' viewpoints that health plans are not adequately explaining their methodology, data collection, and what the measures actually mean for patients. Nearly 9 out of 10 (89.4%) physicians responding said they do not believe that health plans are appropriately educating their members about what the quality and cost data on hospitals and physicians actually means.
Alan M. Harvey, MD, MBA, president of the Massachusetts Medical Society, says the message from physicians about measurement programs seems loud and clear: "This survey shows that health plans have a lot of work to do with physicians before these programs are readily welcomed into the hospital and clinical settings. Physicians are not afraid of accountability, but we have legitimate concerns about the accuracy, usefulness, and timeliness of the data, and how that data will be used in the future."
Harvey says that in May the Massachusetts Medical Society adopted a comprehensive set of Guidelines for Measuring, Reporting, and Rewarding Physician Performance. The guidelines are available at www.massmed.org/P4P.
"Rising costs are a major challenge," he says, "and physicians are willing to work with everyone to make healthcare affordable so that everyone who needs care can get it. It's been said with regard to these 'transparency' efforts that we have to start somewhere, and we agree. But that doesn't mean we should start anywhere."
"Credible, understandable public information about quality and costs can contribute a lot to improving quality and making healthcare affordable," Harvey continues. "All of the parties need to work together and make sure we do it the right way, so that everyone benefits from these initiatives."
Other key results from the survey: 55.8% of respondents said they believe the current programs will worsen (43.1%) or have no effect on (12.7%) the practice of medicine, and 62.7% said that current cost or quality measurement programs would not influence their referrals to other physicians.
Of the 411 respondents, 29% indicated they practice internal medicine, family practice, or general practice, while 71% indicated a medical specialty. The Medical Society's survey was conducted by e-mail between October 21 and 28 and asked physicians about cost and quality measures for physicians, hospitals, and nursing homes. The margin of error is +/- 3.5%. The complete survey and its responses may be viewed at the Medical Society's Web site at www.massmed.org/p4p_survey.
Source: Massachusetts Medical Society
Palliative Care Programs Surging Trend in U.S. Hospitals
A study released in December in the Journal of Palliative Medicine confirmed that palliative care programs continue to be a rapidly growing trend in U.S. hospitals — a trend widely regarded to be an improvement in the quality of care of advanced, chronic illness. Researchers at the Mount Sinai Medical Center and the American Hospital Association (AHA) report that the number of palliative care programs increased from 632 (15% of hospitals) in 2000, to 1,027 (25% of hospitals) in 2003 — a 63% increase in only 3 years.
"This is a win-win for both patients and hospitals. Palliative care programs provide quality, efficient and cost-effective care focused directly on our sickest and most complex patients. Hospitals recognize that the cost of not providing this type of care is just too high," says Dr. Sean Morrison, one of the study's authors and vice-chair of research, department of geriatrics at the Mount Sinai Medical Center.
Although growth occurred nationwide, larger hospitals, not-for-profit hospitals, academic medical centers, and VA hospitals were more likely to have a program compared to other hospitals. The New England, Pacific, and Mountain regions of the country were also much more likely to have programs.
The goal of palliative care is to relieve suffering and ensure the best possible quality of life for people facing advanced chronic and life-threatening illness. It is provided alongside all other appropriate curative treatment. Hospital palliative care programs have been associated with improvements in both healthcare quality and healthcare costs.
By 2030, 20% of the U.S. population will be older than 65, and most will eventually have one or more chronic illnesses. "Patient demands are changing. People want quality of life and relief from suffering. Usually palliative care programs are flooded with referrals once word gets out that a program has been started," comments Dr. Diane Meier, director of the Center to Advance Palliative Care and one of the study's authors.
The study was compiled using the most recent data (2003) from the AHA Annual Survey of Hospitals 2005. It represents an update of an earlier report published in 2001 and provides the first follow-up to Means to a Better End: A Report on Dying in America Today (November 2002).
Factors that were cited as possible reasons for the rapid growth in palliative care programs were:
- The increase in the numbers and costs of caring for chronically ill Medicare patients. Palliative care programs have been proven to reduce costs.
- Studies that have shown inadequate treatment of pain and symptoms, and poor communication and coordination of care.
- And, the hundreds of millions of dollars that have been invested in the growth of the field by the Robert Wood Johnson Foundation and others.
Source: The Center to Advance Palliative Care
Use of Color-Coded Patient Wristbands Creates Unnecessary Risk
A recent "near-miss" report submitted to the Patient Safety Authority through the Pennsylvania Patient Safety Reporting System (PA-PSRS) describes an event in which clinicians nearly failed to rescue a patient having a cardiac arrest because healthcare workers mistakenly believed the patient's wristband color meant "Do Not Resuscitate" when it was actually meant to convey a different message.
"The problem was caused partly by a healthcare provider's confusion about the meaning of a yellow wristband," says Alan B. K. Rabinowitz, Authority administrator. "In this particular facility, a yellow wristband means 'Do Not Resuscitate,' but in a nearby facility a yellow wristband is used to mean that a patient should not have blood work or an IV placed in that particular arm."
Because the provider worked in both facilities, she inadvertently used the yellow wristband in the wrong facility. When other healthcare workers later saw the yellow wristband, they incorrectly thought the patient was designated as "Do Not Resuscitate."
According to Dr. John Clarke, PA-PSRS clinical director, there are a number of steps facilities can take to make use of color-coded patient wristbands safer. "Although standardizing the meaning of different colors can only be done by coordination among healthcare facilities," Clarke noted, "individual facilities canÝlimit the number and colors of patient wristbands and use printed text to reinforce the meaning of specific colors. They can also reconfirm clinical instructions with both patients and hospital staff."
To assess the potential scope of the problem, the Patient Safety Authority surveyed Patient Safety Officers in all Pennsylvania hospitals and ambulatory surgical facilities (ASFs). The 139 survey respondents represented one-third of these healthcare facilities. The results of the survey and improvements that can be made to minimize patient risk when using color-coded armbands are included in a Supplementary Advisory published by the PA-PSRS program.
Highlights of the Supplementary Advisory include:
- In a recent survey, about 4 out of 5 Pennsylvania facilities responding use color-coded patient wristbands to communicate important medical information.
- There are no standard meanings among healthcare facilities for different colors.
- Limiting the number of wristbands and the colors used may help to avoid confusion for healthcare providers working in multiple facilities.
- Printed instructions on wristbands can help to reinforce the message conveyed by a particular color.
Rabinowitz cites the usefulness of gathering reports in "real time" through the PA-PSRS system as a major contributor in helping improve patient safety by disseminating information about potential risks to facilities throughout the state.
"The wristband issue is not one that will be resolved overnight," Rabinowitz says. "However, by sending out an advisory to all healthcare facilities making them aware of the potential problem associated with color-coded wristbands in one hospital, we are giving all healthcare facilities the opportunity to implement steps to prevent a similar event from happening in their own facility."
For a copy of the Supplementary Advisory on wristbands go to http://www.psa.state.pa.us/psa/lib/psa/advisories/
v2_s2_sup__advisory_dec_14_2005.pdf
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