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.

HPM Physician Performance Management

At a recent regional assembly of hospice executives and Hospice and Palliative Medicine (HPM) physicans who had gathered to strategize about the advantages (and disadvantages) of building a provider network for late-life care, I was asked what tools are available to measure performance of HPM physicians (and nurse practitioners).  I suggested turning to the Joint Commission's standards on OPPE (which I have written about previously, read here) for a closer look into how hospitals are expected to evaluate  their medical staff practitioners. How might these standards be applied for HPM physicians in the hospcie setting?  Here's one approach to applying physician performance core competencies to HPM practitioners we've found successful:  
    
Patient Care. Providing patient care that is compassionate, appropriate and effective for managing
late-life care.

Medical/Clinical Knowledge. Degree of knowledge of established and evolving practices and principles of HPM, as well as the application of that knowledge to patient care and the education of others.

Practice-based Learning and Improvement. Use of scientific evidence and methods to investigate, evaluate and improve late-life care practices.

Interpersonal and Communication Skills. Establish and maintain professional relationships with patients, families and other members of health care teams.

Professionalism. Commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity, and a responsible attitude toward  patients, the profession and society.

Systems-based Practice. Understanding of the contexts and systems in which palliative care is provided and the ability to apply this knowledge to improve late-life care.

Of course, specific metrics need to be developed to evaluate performance in each of these domains.  The metrics  will vary from organization to organization and are  less important than the process of sitting down to develop the metrics. Yet,  doing so will take executives and physicians a long way toward satisying one of the building blocks of a high-performing HPM medical staff -  to  foster an unswerving commitment to performance improvement to minimize unwarranted practice variation, reduce regulatory risk, and win the confidence of referring sources.

Performance Management and Palliative Medicine

I hear from palliative medicine physicians whose experiences suggest that their successes often go unrecognized, or at best taken for granted, while their failures are highlighted, particularly during times of program evaluation or subsidy renewal. What prompts these misguided views and feelings? Is it numbers-driven executives who see these palliative medicine practices producing revenue that in best cases meets no more than half of the practitioners' salaries? Or is it underperforming physicians whose practices fail to meet productivity standards? Or is it quite simply a misunderstanding of the value of palliative medicine programs in general, and of palliative medicine physicians specifically?
Our study suggests that another factor is at play here. Call it a misalignment of expectations, a misalignment that manifests itself in role confusion. What is role confusion, and why should palliative medicine be more vulnerable than others to this rather abstract influence? The short answer is that most palliative medicine programs were launched on the proverbial shoestring, and when met with growing demand for their services, turned their attention to their most recent referring sources. These new referring sources, of course, were not the ones behind the launch of the program. Additional MD or NP resources to serve this growing demand are months way from being hired, if at all. And so we find role drift, which inevitably leads to role confusion. This is the time, we find, for the introduction of performance management programs.