What Do We Want Out of Physician Performance Measures? Developing a Conceptual Frame

1. What Do We Want Out of Physician Performance Measures? Developing a Conceptual Frame Carolyn Clancy Lisa Latts AHRQ National Advisory Council November 4, 2011

2. Prevalence of Financial Targets for Quality Improvement Bonuses Tied to Medicare’s Star System Reward Insurers “For the first time, a government-backed quality rating will have a financial meaning to health insurance companies looking to attract millions of older Americans to privately run Medicare coverage next” Bruce Japsen, New York Times (10/12/11)

3. The Evolving Doctor-Patient Relationship • This era is ending, being replaced with consumerism and the movement toward shared decision making • Teutsch, C. Patient–doctor communication. The Medical Clinics of North America 2003;87:11-15-45. • Previous research has demonstrated a strong relationship between patient-centered patterns of communication and higher levels of satisfaction and trust • Jackson JL. Communication about symptoms in primary care: impact on patient outcomes. The Journal of Alternative and Complementary Medicine 2005;11(Supplement 1):S-51–S-56. • There is a 19 percent higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well • Haskard Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Medical Care 2009 August;47(8):826-34.

4. Patient Engagement “The core point at which health care costs explode is the point at which the doctor and the patient sit down together to make a decision about what they should do. We have not concentrated enough, in our thinking about reform, on that moment.” Atul Gawande Time magazine January 4, 2010

5. Patient Engagement History Campaign update encourages patients to prioritize their questions AHRQ/Ad Council exploratory research finds patients worry about errors, but don’t feel empowered to take action AHRQ initiates 5-year, $150M in patient safety funding To Err is Human: Building A Safer Health System 1999 2000 2001 2002 2005 2007 2009 2011 Questions are the Answer Campaign First TV ads feature singing/dancing health care professionals Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors Harvard/Kaiser surveys find 42% of public and 35% of physicians report experiencing errors Campaign Refresh Adds Clinicians to the Target Audience

6. The Conflict Quality Improvement Patient Engagement

7. Possible Repercussions • Minimization or inhibition of nascent empowerment/activation initiatives • Physicians may fire or discourage “noncompliant” patients from their practices • Pushback by providers to QI initiatives • Quality targets less than 100 percent

8. Feedback We need your ideas!