Physicians like tools, are anxious for info

Docs want data to negotiate MCO contracts

For Lawrence A. Caliguiri, MD, the ability to track the outcomes of his asthma patients holds promise on many fronts. As a board- certified allergist practicing in Pittsburgh, he will use the outcomes data to tweak individual patient treatments.

As president of an independent practice association (IPA), he will use aggregate data to help establish optimum treatment regimens and best practices for the IPA. And as a small business entrepreneur negotiating with managed care companies, the data will help him sell his IPA’s services more advantageously.

These were the reasons Caliguiri became involved in the Asthma Outcomes Monitoring System pilot program. He’s very positive about its potential, as are many of his 12 association colleagues, who practice in 29 counties in western Pennsylvania. The AOMS tools compare very favorably against some other instruments he has used, he says. And although administering the assessment tools probably increased his staff’s work about 25% during patient visits, he staunchly maintains that they are worth the effort.

"I like them for several reasons," Caliguiri says. "First, they allow the patients to organize their thoughts so that when we interview them during a visit, which is typically quite short, we can hold more substantial conversations, get more done.

"Secondly, the objective criteria, the clinical measures, are quite important because they give us a quick review of how the patient is doing," he continues. When the technology is in place to get this data to doctors at the point of service, it will be especially valuable in fine-tuning individual treatment regimens, he says.

"And thirdly, I think it is very important for us to look at the treatment plans we have in place and try to improve them on a continuing basis," Caliguiri adds. This is where the aggregate data will be most useful, he says. "Each month, we get together as an IPA and we discuss our data, but what we have lacked in the past has been data on outcomes. Having outcomes data will make a tremendous difference in our discussions."

Most patients responded very well to the program, saw the benefit of the surveys and conscientiously filled out their encounter forms. Only one of his patients said he didn’t have time to complete the questionnaires, says Caliguiri, who also is a clinical professor of pediatrics at the University of Pittsburgh School of Medicine.

Martha Bayliss, senior director of clinical applications at QualityMetric in Lincoln, RI, and project director for AOMS, recalls that early in the pilot many of the quarterly surveys were returned with notes that said, "Thank you for asking me these questions."

"The point is that something had been missing from their encounters," says Bayliss, "something that they cared deeply about and were so pleased that someone was asking them about. Now that puts the ball in our court to say to the doctor, Now you know that your patient is not doing the things that he or she wants to do, and you have an obligation to do something about it.’"

That kind of interaction will only be possible when the outcomes data are available on a timely basis, says Caliguiri, which means the vendors must make the automation offered to practices like his both efficient and cost-effective. So far, in talking with vendors, he has been disappointed in what they are offering. But it is still early in this phase of AOMS development, so he hopes that as more vendors get involved, he’ll find a technology solution that both fits his practice and his pocketbook.

Meanwhile, the aggregate data from the pilot and his IPA’s ongoing participation in the project should help him negotiate better contracts with managed care companies, Caliguiri says. "We have the impression that we have better care and better outcomes, but until we have the objective data, we cannot prove that to be true," he says. "MCOs say, show us,’ and until we do, they just won’t listen to us."

[For more information, contact Martha S. Bayliss, Senior Director, Clinical Applications, QualityMetric Inc., 640 George Washington Highway, Lincoln, RI 02865. Telephone: (401) 334-8800. E-mail:]