The trusted source for
healthcare information and
Expanded projects seek more feedback, less burden
Recognizing that health plan ratings give only a limited picture of health care quality, nonprofit groups in California and Massachusetts are looking for ways to expand measures to hospitals, medical groups, and even individual physicians.
The California HealthCare Foundation, based in Oakland, launched its Quality Initiative, in part, to explore performance measurement and accreditation at the medical group level. This year, the foundation and the California Hospital Association sponsored a survey project to measure the quality of the patient experience at 140 hospitals statewide. The foundation will publicly report results after giving hospitals a year to conduct quality improvement.
"Publicly reporting the data [alone] stimulates improvement," says Ann Monroe, MA, director of the Quality Initiative. Medical groups also could benefit from the feedback of a measurement system, she says. "Without that kind of common metric across [medical groups], quality improvement activities are driven not by what standardized measurement shows as your areas of improvement, but what you think is important."
Meanwhile, organizations such as the California Health Care Foundation are concerned about lessening the burden and expense of data collection, both for medical groups and health plans.
That concern prompted the Massachusetts Health Quality Partnership in Boston to study the feasibility of a collaborative that would allow health plans to jointly sponsor a patient survey about care provided by individual physicians. Physicians would receive their own results but the data would not be publicly reported, says Gina Rogers, a founder and now a consultant with the Health Quality Partnership.
Balancing the need for accurate and valid data with the cost and burden of data collection is a delicate task. A recent article in the Journal of the American Medical Association highlighted the large sample sizes that are needed to distinguish quality differences among physicians. (See Patient Satisfaction & Outcomes Management, August 1999, p. 87.)
Health plans currently survey members about their experiences with physicians, but often, the plans don’t capture a large enough sample size to make comparisons valid. "If you really want to use a survey like this to compare [performance] at a physician level, you have to [have] an awful lot of surveys," says Rogers. "No one plan can afford to do that at the physician level."
A collaborative effort would improve the validity and usefulness of the surveys by creating a much larger pooled sample size. The surveys would include questions about preventive care, the patient’s opinion of the doctor’s technical competency, and doctor-patient communication, Rogers says.
Because the collaborative would simply involve a new method of collecting information that individual health plans already measure, the concept has not garnered opposition. However, it is still in formative stages. "Our mission right now is to have an improved set of information flowing about the physician to the health plan," she says.
Finding relief from data burden
For medical groups, the expense and burden of collecting quality-related information can become overwhelming when they must fulfill redundant demands from different entities, Monroe says.
To address that concern, the California Health Care Foundation is considering whether to cultivate a new physician organization accreditation program. Such accreditation ended when the Medical Quality Commission in Seal Beach, CA, disbanded in 1998.
"Medical groups are inundated with inspections, audits," says Monroe. "We have medical groups that have 50 audits a year — from every health plan for every line of business, HMO regulators, state health departments. It’s a lot of duplication and repetition."
The California HealthCare Foundation also is working in partnership with the Pacific Business Group on Health (PBGH) in San Francisco to expand the scope of the Physician Value Check Survey, a patient survey that is used to measure and report the quality of medical groups. For example, the foundation is sponsoring a statewide public information campaign to inform consumers about how to judge health care quality and where to find information on medical groups, hospitals, and health plans.
Monroe also would like to see even more groups join the voluntary project. The Physician Value Check Survey now covers 63 medical groups, including most of the large medical groups, says Cheryl Damberg, PhD, PBGH’s director of research and quality. California has about 300 medical groups, many of them with just a few physicians.
Currently, neither the foundation nor the business coalition plans to collect data at the individual physician level. While in some states, a medical group may have little identity for consumers, in California, many medical groups have taken on some responsibilities of managed care organizations, such as credentialing or utilization review. "For our purposes, it is an appropriate unit to hold accountable," Damberg says.