In the new era of value-based payment, how physicians use performance measures and data offers the potential to make strides in improving health outcomes. The new payment systems need to be designed around patient care, experts agree. One surgeon recently shared his point of view and explained how his association is using data to improve patient care and creating technology tools that could benefit physicians across the country.
A payment system designed around patient care, not the reverse
When we look at performance measures from a physician standpoint, “they’re traveling down one of two pathways, whether it’s [the Merit-based Incentive Payment System (MIPS) or alternative payment models (APM)],” Frank Opelka, MD, said at a recent Health Affairs’ forum, “Envisioning the future of value-based payment (podcast).”
Dr. Opelka is a professor of surgery at Louisiana State University (LSU) School of Medicine, chair of the Physician Consortium for Performance Improvement, and medical director of quality and health policy at the American College of Surgeons (ACS). He also is leading a statewide effort in Louisiana to use data for quality improvement, real-time clinical decision support and outputs for national data registries.
It doesn’t matter whether clinicians are in the MIPS or an APM, Dr. Opelka said. “This is all about patient care, not a payment system … we’ll tack on a payment system … that’s how [clinicians] are thinking about this.”
According to Dr. Opelka, performance measures should do two things:
- Regardless of the path a clinician takes—MIPS or an APM—performance measurement should reflect the patient care provided, not the payment system.
- Clinicians need consistent measurement infrastructure using advanced analytics, multiple data sources, and registries—all of these represent a much larger clinical data ecosystem than electronic health records (EHR) can ever offer alone.
EHRs will be one component of what must be a larger cloud architecture that grants access to much-needed data to improve patient care, Dr. Opelka said.
This means looking toward a future state, where EHRs are the access point. Like a Web browser, they can be doorways into a much larger world of data, but must be usable, flexible and adhere to industry interoperability standards.
But, data are difficult to gather into one place at the moment. Physicians and other health care professionals know that data can “give them an active dashboard that allows them to drive optimal care,” Dr. Opelka said. “In all the rest of their industries—banking, groceries, Amazon, you name it—they can get information that’s useful to them. We haven’t built that yet out of the architecture that’s in the [medical] data world.”
How surgeons are using data to improve care
Dr. Opelka and his colleagues at ACS, through the National Surgical Quality Improvement Program (NSQIP), have developed a cloud architecture that holds the clinical data from registries that they need at the point of care. Through this cloud, they are able to identify indicators that allow them to predict what may affect specific groups of their patient population and get a head start on treatment. They are building dashboards for every surgeon at every point in the country that will gather cost data and patient data when they need it.
For example, a surgeon seeing a cancer patient can go through their EHR and click through to see the date of diagnosis, the stage, previous operations, and chemo or radiation treatments—all separately. “Or I can build it into a dashboard so that when that patient comes in, it’s presented to me,” Dr. Opelka said. “Instead of looking at [the EHR] and clicking through, I can actually stop for a minute and take a look at a patient.”
Anyone who’s used an EHR knows they hold a lot of potential. “It’s done marvelous things to bring the data architecture forward, but it’s not the end point,” he said. “Stop looking at EHRs and look at the cloud [and] what attaches to the cloud.”
Public servers, payer servers, clinical EHR data, lab data and connections to other care points are just a few of the components that Dr. Opelka suggests should be attached to the cloud. “We’re starting to frame data in an architecture that I clinically can say, ‘I know what I’ve got to do,’” he said.
Here are two ways Dr. Opelka said his health system at LSU uses the cloud architecture to help patients:
- Pollen season. When the pollen count begins to rise, the practice checks the EHR to find all of their patients with asthma who have any kind of inhaler and check the pharmacy data set to see whether or not the inhaler prescriptions are renewed, current and active. “Those that aren’t get a smartphone message to get it in line because the pollen are coming,” he said. “That’s how you leverage data for better health care, and that’s how we ought to be looking at this.”
- Mardi Gras. “We have issues with Mardi Gras,” Dr. Opelka said. Using the cloud the Thursday before Mardi Gras begins, the practice texts a message to all patients with diabetes, asking them to send their blood glucose readings for the next five days, through Fat Tuesday. “Then we put in alerts back to the [primary care physicians] when somebody is off the charts,” he said. “We try and get in front of where that patient is heading. This is how big data can be leveraged. When you put it together, you form collaboratives that lead to people working together to drive improvement.”
“When we look at it from the American College of Surgeons’ standpoint, we’re registry based,” he said. “Five registries with terabytes of information—the national cancer database, the trauma database, the national surgery quality improvement database—[we] have over 800 data elements with about five to six metadata elements per data element moving into this framework today.”
“We’ve automated a third of that,” he said. “Within the next two years, we will have all of it automated. These are data flows that are moving then to the point of delivering health care. We have to have reliability and validity that physicians can trust, that the patient can trust.”
One of their many registry outputs shows the performance of each hospital involved in the NSQIP, from outstanding to underperforming. “These are benchmark activities that should be coming back at least quarterly to the clinical teams,” he said. “I want to look at all aspects across the continuum of care, of all the providers, not just me the surgeon—how are we as a team delivering?”
Through the use of this registry output, 82 percent of hospitals decreased patient complications, 66 percent of hospitals decreased mortality rates and each hospital prevented 250-500 complications annually.
“When you give people data like this, they love it and they hate it,” Dr. Opelka said. “They only want more. Once you create that addiction, now they’re going to react to it. It’s genetically bound to us from the moment we’re born. We start walking, and we want to keep up with our mother. And the next thing you know, we’re running, and we want mother to keep up with us—we compete.”
For more on data use in practice, read how a practice in Minnesota is using patient data to enroll patients in diabetes prevention programs.