Embracing 'Quality' Medicine

July 31, 2013
Owen Dahl

If you are an independently minded physician, take heart. There is a way to work with new quality standards and still retain your autonomy.

There are three things in life that are certain: death, taxes, and (my own addition) change - especially in the healthcare world. Whether or not the Affordable Care Act fully sees the light of day, there are many aspects of healthcare reform that will continue to affect our world. Reimbursement models will change, with fewer fee-for-service plans and more "bundled" payment options. Payment will be based more on delivering optimal patient outcomes and utilizing evidence-based treatment protocols.

This approach creates an interesting problem for the independently minded physician. Physician training programs have traditionally been designed to build skills in diagnosis, treatment, and symptom management. They also demand personal accountability for decisions that are made on behalf of each patient. Physicians accept this responsibility while also expecting fair reimbursement and respect for their skills and time.

So, how does this ethos work in an era of payment reform, where physicians are asked to subscribe to evidence-based, aka, "cookbook" medicine and quality improvement programs? In many cases today, the "means" are being measured rather than the "ends," which is counter to most physicians' training. I know, it sounds terrible, but don't despair, there are ways to work with the new "regime."

First, it is important to understand exactly what the future will hold. Currently we are in a transition (perhaps a better word than change) from the way things have been done to a new world based upon evidence-based treatment protocols. "Someone" determines what the best treatment option is for a patient, the payer agrees, and the physician is asked (forced may be too strong a word here) to treat each patient with a particular diagnosis in the most cost-effective manner (notice I don't mention quality). If the care plan is followed, payment will also follow.

How then is the independent-minded physician going to be able to make this transition? It is difficult since each of us is unique. This conundrum that faces physicians is causing many to leave the practice of medicine, many to consider early retirement, and others to stay and work within the system.

While I am not a physician and would not pretend to be, there are a few things that come to mind to assist in making the transition:

• Understand and accept these changes as reality, don't panic since they won't occur instantly, but gradually over time.

• Work within your group (formal or informal, e.g., IPA) to develop appropriate education, resources, monitoring, and measurement strategies to create treatment-plan options.

• Work within your group to ensure that there is assistance in compliance that will lead to successful outcomes.

• Use the appropriate diagnostic tools and information exchange (to eliminate test duplication) to get timely information about patients.

• Work with your administration to make sure the necessary guidelines and resources are available at all times - lay administrators can and should be part of the future team.

• Approach each patient as an individual and use your own best judgment. Patients may not always fit each "recipe" in the cookbook; they might be better off with your customized treatment plan. This may require extra work, but each patient deserves the best option.

Fortunately, there is time to make the transition to the evidence-based, bundled-payment future of medicine. Stay the course and continue to do what you do best: treating patients.

Owen Dahl, FACHE, LSSMBB, is a nationally recognized medical practice management consultant and author of "Think Business! Medical Practice Quality, Efficiency, Profits" and "The Medical Practice Disaster Planning Workbook," and coauthor of "Lean Six Sigma for the Medical Practice: Improving Profitability by Improving Processes." He can be reached at odahl@owendahlconsulting.com or 281 367 3364.