Presentation slides given at UHC annual meeting on physician performance and alignment with strategy.

1. Tufts Medical Center:
Blurring the Lines
University HealthSystem Consortium
Annual Conference 2012
Friday, September 14, 2012

2. Blurring the lines
Value
Physician Hospital
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3. Context – Organizational alignment
• Tufts Medical Center
– Founded in 1796
– 350 bed full service medical center
– Located in downtown Boston
– Primary teaching hospital for Tufts
University School of Medicine
– 44 GME programs with >400 residents
and fellows
• Tufts Medical Center
Physicians Organization (Tufts
MCPO)
– Academic multispecialty group
practice
– >500 physicians organized into
17 clinical departments
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4. Goals of professional practice evaluation
• Quantitative assessment of provider performance in
multiple domains
• Optimize the use of existing data repositories
• Assist the Chairs in the development of these reports
• Align physician and hospital goals and objectives
• Optimize our organization’s delivery of value based
healthcare
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5. Organizational Alignment and Leadership Focus
Department Chair
Physicians Medical Medical
Organization Center School
Look for leadership levels that provide the greatest breadth and
focus to provide leverage for your initiatives. In most organizations,
the departmental chair is in the key position to drive academic,
hospital and physician performance.
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6. Why evaluate physician performance?
• Joint Commission
• Pay for performance
• Public perception
• Improving patient care and experience
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7. Joint commission -
Focused Professional
Practice Evaluation
Ongoing Professional
Practice Evaluation
Continuous Professional
Practice Evaluation
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8. Pay for Performance
Financial Risk
Physician Hospital
HMO putting PCPs VBP putting
at risk for HEDIS & hospitals at risk for
Metrics and Physician experience performance on
measures quality, safety and
performance HCAHPs
HMO putting PCPs performance
measures at risk for hospital
Hospital Q, S and HCAHPs
measures
Depending on the details and structure
Global and
of the contract – both physicians and
Bundling hospital will have financial risk
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Michael Wagner, MD 2012

9. Pay for Performance
MHQP website
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10. Public Perception
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11. What is Physician Performance?
Domains Outcomes
– Medical Knowledge
– Patient Care – Processes of care
– Practice Based Learning
and Improvement – Safety / Harm
– Systems Based Practice
– Professionalism – Patient experience
– Interpersonal and
Communication Skills
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12. DO – DOC – DATA
Do Document Data
care provided care documented care codified
Physician Facility
Inpatient X X
Outpatient X X
Combined X X
MR
CDI
Forms/EMR
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Michael Wagner, MD 2012

13. Figuring out physician performance is like a puzzle
The essential point of physician evaluation is to focus on the key aspects
of the picture. You do not need to complete the entire picture in order to
understand the physician’s competency and performance. Unlike a
puzzle you might complete with your kids, you don’t start at the edges,
but start at the central aspect and work your way out.
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14. Data – you have more than you think
• MHQP
Patient
experience • PG ambulatory
• PG inpatient
• Core Measures
Aggregate • Safety events
Inpatient
Physician data • UHC repository
Performance
• TSI
• EMR reporting
Ambulatory • Meaningful use
/ outpatient • Repositories
• Billing data
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15. Working outline of process
TSI
UHC
Data pulled Summary
by specialty Divisional Reports Report by MD
One App and peer group
IDX / and provider Databases
FPSC
Press
Ganey Validation
process
MQIP Fix errors
MD leadership / MD feedback
Fix process
Blood
OPPE / FPPE / PO
HIM

16. Lessons Learned
• Attribution
• “Those are not my cases.”
• Documentation and Coding
• “The report is wrong, I didn’t have any accidental punctures.”
• Data lags
• “This data is too old.”
• Understanding of metrics, risk adjustment, etc.
• “This doesn’t make any sense. Why is this important?”
• Integration challenge
• “We use another system for that.”
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17. Adjustments made
• Focus with flexibility
• There are data lurking everywhere
• Clinical data is most helpful and relevant –
administrative data is the most problematic.
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18. Next steps
• Surgical specialties
– Focus on patient safety indicators
• Medical specialties
– Develop method to compare physicians based on their clinical
focus
– Non-procedural areas – finding quality data that is attributable at
individual physician level
• Alignment of annual Chair goals with hospital, VBP and
other quality, safety and experience initiatives
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19. Thanks
• Brian Collins
• Karen Reed
• Linda Nolan
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20. Questions
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