Tuesday, September 27, 2011

Tracking HPM Physician Performance - Physician Value Index

At a recent regional symposium  for  hospice executives and chief medical officers, following a presentation on the building blocks of a high-performing medical staff,  I was asked  how I would assess if the performance of a hospice medical staff is "high-performing". Of course, there is no single answer, but we (DAI Palliative Care Group)  have developed a tool that has successfully been used to benchmark performance.

Many factors weigh in upon the performance of HPM physicians within a hospice setting. Some factors can be quantified, many cannot not. So, based upon years-long study of hospice physician practices, our research group developed  a metric we refer to as the HPM Physician Value Index , or HPM-PVI. As with other indices, such as an economic index used to track changes in the economy, the HPM-PVI is a single number calculated from an array of figures. In other words, it is a statistical composite that measures changes from one period to another, and can be used to help answer a question often posed by hospice executives - "how can I  determine if I'm getting a reasonable return for the investment (physician compensation) in the medical staff"?

The HPM-PVI has served as a useful metric because it assigns a value to one of a hospice physician's principal activities - oversight of an interdisciplinary team. I invite your feedback and participation in our ongoing efforts to spread the use of this HPM physician value index.

Hospice and Palliative Care - Diffusing the Health Innovation

A graduate student in a Health Policy program asked me during a Q&A session at a national colloquium why I characterize end-of-life care in this country as three parts potential for two parts accomplishment. I've been asked similar questions before, but what gave me pause this time was the context of the query (the workshop was addressing the issue of access to hospice). The previous speaker had just presented a strong case statement on why access to hospice has been threatened by the "cap". And why the main reason for the decelerating growth of hospice was poor reimbursement.
I replied that the delivery system for late-life care is fragmented, and there is insufficient collaboration among providers within most communities. Thus, conditions are uninviting for the "spread of the science" (palliative medicine and nursing). The Center to Advance Palliative Care (CAPC) has effectively spread the science throughout the hospital sector, as it relates to hospital-based palliative care services. No small accomplishment, to be sure. But the other major palliative care providers (hospices) have been slow to scale, in part because hospices have taken competitive stances to protect their market share rather than the collaborative approach which studies have shown to be more conducive to the dissemination of best practices. A recent post described the current structure of the hospice industry. Communities known as providing high-value late-life care are characterized by several attributes - one of the most defining is a coalition (some might say network) of palliative care stakeholders (organizations and individuals) which come together to deliver care across settings and boundaries. The beginning of an Accountable Palliative Care Organization (APCO), some speculate.

The structure of the social system can facilitate or impede the diffusion of health care innovation, concluded Thoms Bodenheimmer, MD, in a September 2007 report for the California Health Care Foundation on how innovations in health care become the norm. Do the current social systems in our communities best position HPM leaders to 'spread the science"? As always, your comments are invited.