From denial to acceptance: Getting doctors behind performance data

As the Center for Medicare & Medicaid Services prepares to enhance its Physician Compare website to include quality of care information, practices across the country are getting ready to share data on the care of their Medicare patients or face penalties come 2015.

Publicly reporting performance measurement data is something we have been doing for the past seven years with 16 communities across the country as part of the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative. These communities publish reports about the quality of care physicians provide so that the information can be used by everyone who gets, gives, and pays for care.

What we have seen in our work with physicians as we report data on their performance is something akin to watching someone go through the stages of grief. Physicians are initially a little defensive. They feel that their decisions when treating patients are nuanced, and can’t be judged by objective measures. Then, they deny the results, and often question the validity of the data itself. But gradually there is acceptance. They come to see that the data from measuring and reporting is a useful tool that can be used to help improve the care they provide day in and day out to patients. It is at that point when we see real potential to improve the quality of care.

The road to acceptance is not an easy one, and physicians tend to have conflicting perspectives on publicly available performance information. Some of us see value in learning how practices compare to national or local benchmarks to see where they can make improvements. But there is also concern whether the information that is reported is an accurate portrayal of the medical practice, or if the data is meaningful to patients.

We’ve learned that motivating and engaging physicians are key factors in getting to the acceptance stage. In Wisconsin, when the Wisconsin Collaborative for Healthcare Quality began reporting performance data about its member practices, they were motivated to raise their game so they could be identified as a top performer and stay off the bottom rungs of the ladder. Practices improved performance on every one of the 14 reported ambulatory care measures, with the greatest improvements in diabetes-related measures.

The Health Collaborative in Cincinnati worked with its physician leadership group to engage physicians around data on diabetes care by providing group learning sessions and one-on-one coaching to the physicians. This resulted in a 7 percent increase in the number of primary care providers meeting the average rate of five key diabetes measures in the first year of the program.

In Cleveland, when Better Health Greater Cleveland reviewed its data on pneumonia vaccination among diabetes patients, it noticed that the MetroHealth System had the best performance. The alliance asked MetroHealth to share best practices with other systems so they could match the interventions. Vaccination rates in practices across northeast Ohio climbed from 70 to 82 percent in three years.

These improvements would have not been possible without transparent performance data. Public reporting of performance is not about playing gotcha. Rather, it is data that can make a difference. As we prepare for the Physician Compare enhancements, we hope the lessons we’ve learned can be brought to scale and that doctors will see the true value in performance measurement and reporting.

Robert Graham is national program director, Aligning Forces for Quality.

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