Do you talk to your physicians?
By John Whittlesey
Are you speaking with your physicians?
I mean really talking to them, face to face, honestly, and letting them know how they are performing? When I’m on the road doing presentations to clients, talking about clinical excess, the cost of off-quality, or physician variation, usually there aren’t any physicians in the room. And if there are, most will have absolutely no idea what benchmarking is. Nor that the hospital is participating in comparative analysis, or that the doctors’ clinical costs are even being evaluated. So, needless to say, getting buy-in on performance improvement projects from the physicians can be tough.
I always encourage senior management teams to show their physician leaders the data, talk to them about the quality of care issues in the organization, profitability (or lack thereof), and engage them to find a solution. The data that we use for the Clinical and Quality benchmark is straight from the facility’s own databases – though I might recommend blinding it to protect the guilty.
The best example of a collaborative executive-physician discussion I’ve seen happened a few years ago. It was at OSF St. Anthony Medical Center in Rockford, Ill. I was asked to come in for a special session with their orthopedic surgeons. The management was trying to build a case to go to capitated pricing for joint implants. They assembled a nice array of national, internal, and HMC benchmarking data to prove that the hospital was losing money on each joint case. That data also demonstrated the facility’s comparative cost per case was higher than the national averages, and the sales reps were would soon be making more per case than the hospital would. The management didn’t want to limit the vendor list, since each surgeon used a different product line, but they needed them to not side with the sales reps when the letters went out demanding capitated pricing. It worked beautifully, and they’ve moved from one of the highest cost per case facilities in the HMC database to being consistently one of the lower cost per case peers, all without a significant change in vendors or product offerings. They’ve replicated this dialog- based strategy with their spine surgeons and cardiac surgeons, as well.
So whether you’re using our benchmarks or your own internal data, there’s really nothing wrong with posting comparative cost and or quality results for your medical staff in conspicuous places, such as the physician lounge or the surgery lounge. You do it all the time with your own quality or PI results, so why should the physicians be exempt? I would also recommend developing your own internal physician dashboards or scorecards. This would not be specifically for credentialing purposes, but more to provide an opportunity to have an open, honest conversation with doctors about a multiple of indicators (e.g., cost per case, LOS, off-quality cases, variance reports, profitability, problematic DRGs, et cetera). Physicians are very data-driven and generally don’t like to be outliers. But if they have no idea how they stack up against their internal peers, how can you expect them to participate in PI initiatives?
John Whittlesey is a principal at HMC.
