Defining Quality in Patient Care Should Include Predictable Outcomes

In healthcare, practices nationwide are constantly striving to boost quality, working to figure out what that actually means, or silently holding tight, hoping that either a better definition or clearer guidelines emerge amidst ongoing challenges in the industry.

But one thing is for certain: Your practice needs to increase its quality when it comes to patient care.

“Improving quality is not an option,” said Randy Cook, president/CEO of Brentwood, Tenn.-based Ampliphy Physician Services. “You have to do it. It doesn’t matter whether we think we can.”

During an educational session at this year’s MGMA11 Conference in Las Vegas, Cook discussed the traditional concepts surrounding quality, by patients and physicians, as well as a new element he said is a vital component in better defining and getting a handle on quality at your practice.

Cook, who previously worked in managed care and now advises physicians in payer negotiations, repeatedly stressed that quality is not going away when it comes to healthcare.

Whether it is in the form of the decline of fee-for-service medicine and the corollary incline in fee-for-quality medicine or physicians being asked to prove their “quality” for health plan tiers or ACOs, medical homes, or other emerging models, the outlook is clear. “This will happen, no matter what,” he said.

One of the ways practices and others in healthcare define quality, Cook said, is by looking at safety, in the form of reduced errors and accidents in their offices. But if you compare failure rates in hospitals, for example, to airline baggage handlers, the latter have a much better success rate.

“For over 40 years [in healthcare], safety has been used as a surrogate for quality,” he said. “…We need to still focus on safety, but it is not enough. It is not an adequate definition of quality.”

Now consumers, he noted, use service as their “quality surrogate,” happy that wait times are low or service was what they expected when they walked in the door. Comparing customer service of healthcare versus another industry - this time hotels - he noted healthcare falls behind in making consumers/patients feel more cared for.

Again, Cook noted, services is important, but it is not the lone definition for quality.

Cook’s addition to defining quality includes both safety and service, but also adds a new element: predictable outcomes.

“What I mean by predictable outcomes is that the patient arrives at the end of the treatment, in the expected condition, at the expected time, at the expected costs, with increasing reliability,” Cook said. “This applies to all patient conditions, from the common cold to terminal illness.”

Where practices come in, he said, is process control - reducing variation around the treatment process to both improve quality and decrease cost.

“Now if that is not a prescription for what ails us in healthcare, I don’t know what is,” he said.

Cook described an improvement cycle for patients that first defines the outcome, then identified the steps to follow - reduce variations, measure the change, and then repeat for other patients - to better define the process for making ongoing improvements.

Practices already have the tools currently at their disposal to keep track of patients’ progress and reduce variation, he said, from an EHR’s disease registry to identifying a practice population for a specific treatment plan to what he calls a “disease champion.” This person (or persons) looks at the evidence-based data produced at the practice from process control and looks for tweaks to the system, ways to challenge higher results, and other methods to drive the goals of improved quality and decreased cost.

Not only are predictable outcomes an important part of the quality equation, Cook noted, but they also boost their quality “surrogates,” safety and service.

“We need to improve our process,” he said. “If we do process control, we create more predictable outcomes, but we also produce better service and increase safety.”

With quality seen as a savior to healthcare by many, Cook noted that physicians and practice administrators are the perfect individuals to drive how it is defined. He advised them not to be afraid of punishment for inaccurately defining quality or letting others define it for them.

“If you define quality for yourselves,” he said, “you will likely be the first ones in your market to do it …and that will affect your business, from payers to customers.”