Peer comparisons, more $$$ motivate Kaiser docs
Variables make full compliance unlikely
Most physicians regard the creation of standardized medical care as an infringement on their right to practice, notes health care management consultant Kenneth Marcoux, president of the Boulder (CO) Healthcare Group, but he says there’s every reason for those practicing in a managed care environment to want to use what some call "cookbook medicine."
In addition to disease state management providing better, more consistent care for patients, Marcoux contends, there’s a profit factor built in, especially with a capitated system.
That’s the case with the Kaiser Permanente health system, which employs a couple of different incentives to prompt its physicians to use data from information systems to enhance patient care. Not surprisingly, the most effective is the one that affects their pocketbooks.
Disclosure improves physician compliance
When physicians get a reminder from the information system to, for example, use aspirin therapy for heart patients, they may or may not act on it, says Allan Khoury, MD, associate medical director of medical information for Kaiser Permanente of Ohio. Because heart patients tend to be elderly, he notes, physicians simply overlook preventive measures.
The compliance rate goes up when physicians receive quarterly batch reports, showing their status compared to their colleagues in adhering to system guidelines, Khoury says.
"The report says, In your panel of patients, this many have coronary disease, and this many are taking aspirin, so your compliance is this percentage,’" he explains. "Then it compares them with their colleagues."
Compliance with the aspirin therapy guideline reached about 63% through the use of system reminders and went up to 75% with the batch reports, Khoury says. But when a financial incentive was added, the compliance rate hit 81%.
"That’s about the most you’re going to see," he adds. "We consider above 80% full compliance." That’s because there may be that many cases in which the patient is not taking the aspirin for a good reason, but they’re so rare it’s not worth identifying them, Khoury explains.
Good performance reaps rewards
Kaiser primary care physicians can earn up to 30% extra salary by performing well in several areas, such as patient satisfaction, productivity, and clinical guidelines, he says. About 20% of that extra percentage has to do with clinical issues, so theoretically, adhering to the aspirin therapy could mean about 6% more pay. The clinical guidelines are rotated periodically, Khoury notes, and some are more problematic than others.
With it’s congestive heart failure drug intervention, for example, Kaiser has seen its compliance rate improve only slightly, from 54% to 66%, he says.
"I think we haven’t seen full compliance for several reasons," Khoury says. "We may be counting people who really are not appropriate for that intervention because they have diastolic heart failure rather than systolic. Also, the system may not know of past [negative] experiences with these medications.
"Another reason," he adds, "is that starting people on these medications is a burdensome task that requires repeat visits."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content