Finding the path to better hospital quality

Dr. Patrick J. Torcson has always been passionate about caring for the sickest patients and about ensuring the highest quality of care. So when he read Dr. Bob Wachter’s article in JAMA in 2002 showing that the movement to the hospitalist model was saving money without sacrificing quality or patient satisfaction, it led him to make the jump to become a full-time hospitalist (JAMA 2002;287:487-94).

Dr. Torcson established the hospital medicine program at St. Tammany Parish Hospital in Covington, La., in 2005, and still runs the program today. He’s also involved in the public policy and performance measurement committees at the Society of Hospital Medicine and serves as the SHM representative to the American Medical Association’s Physician Consortium for Performance Improvement, efforts aimed at ensuring that quality reporting programs are fair and relevant.

Courtesy St. Tammany Parish Hospital

In an interview with Hospitalist News, Dr. Torcson shared his thoughts on the current quality reporting programs and the ones coming down the pike.

Hospitalist News: Physicians are doing more quality reporting now than ever before, do you think this leads to improved care?

Dr. Torcson: The evidence is mixed as to whether quality reporting and pay for performance actually improve outcomes. It’s important at the outset to distinguish between hospital-level reporting and pay for performance, and physician-level reporting and pay for performance. On the hospital side, we do actually have some results mainly from Medicare’s Hospital Quality Improvement Demonstration Project that showed that when you do public reporting, like on the Hospital Compare website, and you throw some money at the hospitals, that you will get improved quality as determined by adherence to the various performance measures.

On the physician side, there really isn’t any strong evidence showing that paying physicians on a differential basis actually improves quality. It’s hard to have good objective studies of that, but the ones that we have so far, mainly on the outpatient side, really do not show a clear distinction between quality reporting and pay for performance and actually improving quality of care. The lesson there is that maybe trying to do individual-level accountability for what really is systemic care may not work. But clearly we have to do something. We know that the U.S. health care system has tremendous variability in quality and unsustainable costs, so something has to be done to drive a performance agenda to fix this problem.

HN: How relevant are programs like Medicare’s Physician Quality Reporting System (PQRS) to hospitalists?

Dr. Torcson: In some respects it has to be relevant because hospitalists now provide more inpatient care than any other medical specialty. We know that hospitalized patients are the sickest and use the most resources. So performance improvement and performance accountability has to be relevant for hospitalists because of the importance of what we do.

That being said, the PQRS program as it’s currently designed has few relevant performance measures for hospitalists. Most of it was designed around an outpatient focus with that traditional model of doctors in the office also taking care of hospital patients and wasn’t geared toward the model that we have now where most inpatient care is provided by hospitalists. And the actual platform for how the performance reporting is done is not very easy for hospitalists to work with because we rely mainly on hospital-level billing systems to report data.

HN: The physician value-based modifier program is coming soon. What do hospitalists need to keep in mind about this program?

Dr. Torcson: If hospitalists are part of a group of greater than 100 providers, they are under a deadline of October 2013 to establish how they’re going to participate in this program, which will impact their reimbursement starting in 2015. This is something we’ve seen coming down the pike for a number of years. It’s important to remember that the Centers for Medicare and Medicaid Services has put only 1% of our Medicare allowable charges at risk with this pay-for-performance program. And for right now it’s only going to apply to large groups of greater than 100 providers.

The reporting period for the quality measures that will be used in this first iteration is 2013 for the payment adjustment that will occur in 2015. For the rest of us in groups less than 100, the performance period is probably going to be 2014 or 2015 for the payment adjustments beginning in 2017. It’s a small amount of money at risk for right now and it only applies to groups of greater than 100 providers. But definitely stay tuned.

HN: Do you have any tips for how to make quality reporting programs like PQRS less onerous for hospitalists?

Dr. Torcson: Hospitalists should try to take off their clinical hats and even their quality improvement hats and think in terms of practice management. For now, PQRS is voluntary, pay-for-reporting only. So the focus for now is getting your reporting infrastructure in place and that is tied to how you do your billing. It’s a matter of doing the administrative work to see how you submit your claims to Medicare and getting used to reporting the quality data codes, which are part of the PQRS, to those billing codes.

For PQRS, you only have to choose three performance measures. The PQRS has over 260 measures in the program and only 10 are really applicable to hospitalists. You don’t have to hit a home run. Just choose the three measures and figure out from a practice management standpoint how you’re going to attach the quality data codes to your billing codes to get in the reporting game. That’s the best starting point.

HN: Do you think we’ll ever see a payment system based completely on quality rather than volume?

Dr. Torcson: The U.S. health care system is going to be doing a lot of experimentation with alternative payment models. A driving force is to shift financial risk from insurance plans and other payers to providers. That’s going to happen in various payment models like bundling or capitation or the accountable care shared savings methodology.

Pay for performance isn’t necessarily the key to improving care, and regulating change doesn’t seem to work either. What we hope is going to happen is that we’re going to figure out better ways to manage chronic illness and to perform care coordination for the 5% of the population that accounts for 50% of the health care resources.

Looking forward, I think that success for an individual hospitalist is really going to be achieved by aligning with the hospital-level performance agenda. Don’t just think in terms of the individual physician and how you’re going to perform, but really think at the system level.

For hospitalists, in particular, we have a great opportunity through alignment with the hospital-level agenda to really make a difference in terms of how we improve the quality of care and are accountable for costs.

Dr. Patrick J. Torcson has always been passionate about caring for the sickest patients and about ensuring the highest quality of care. So when he read Dr. Bob Wachter’s article in JAMA in 2002 showing that the movement to the hospitalist model was saving money without sacrificing quality or patient satisfaction, it led him to make the jump to become a full-time hospitalist (JAMA 2002;287:487-94).

Dr. Torcson established the hospital medicine program at St. Tammany Parish Hospital in Covington, La., in 2005, and still runs the program today. He’s also involved in the public policy and performance measurement committees at the Society of Hospital Medicine and serves as the SHM representative to the American Medical Association’s Physician Consortium for Performance Improvement, efforts aimed at ensuring that quality reporting programs are fair and relevant.

Courtesy St. Tammany Parish Hospital

In an interview with Hospitalist News, Dr. Torcson shared his thoughts on the current quality reporting programs and the ones coming down the pike.

Hospitalist News: Physicians are doing more quality reporting now than ever before, do you think this leads to improved care?

Dr. Torcson: The evidence is mixed as to whether quality reporting and pay for performance actually improve outcomes. It’s important at the outset to distinguish between hospital-level reporting and pay for performance, and physician-level reporting and pay for performance. On the hospital side, we do actually have some results mainly from Medicare’s Hospital Quality Improvement Demonstration Project that showed that when you do public reporting, like on the Hospital Compare website, and you throw some money at the hospitals, that you will get improved quality as determined by adherence to the various performance measures.

On the physician side, there really isn’t any strong evidence showing that paying physicians on a differential basis actually improves quality. It’s hard to have good objective studies of that, but the ones that we have so far, mainly on the outpatient side, really do not show a clear distinction between quality reporting and pay for performance and actually improving quality of care. The lesson there is that maybe trying to do individual-level accountability for what really is systemic care may not work. But clearly we have to do something. We know that the U.S. health care system has tremendous variability in quality and unsustainable costs, so something has to be done to drive a performance agenda to fix this problem.

HN: How relevant are programs like Medicare’s Physician Quality Reporting System (PQRS) to hospitalists?

Dr. Torcson: In some respects it has to be relevant because hospitalists now provide more inpatient care than any other medical specialty. We know that hospitalized patients are the sickest and use the most resources. So performance improvement and performance accountability has to be relevant for hospitalists because of the importance of what we do.

That being said, the PQRS program as it’s currently designed has few relevant performance measures for hospitalists. Most of it was designed around an outpatient focus with that traditional model of doctors in the office also taking care of hospital patients and wasn’t geared toward the model that we have now where most inpatient care is provided by hospitalists. And the actual platform for how the performance reporting is done is not very easy for hospitalists to work with because we rely mainly on hospital-level billing systems to report data.

HN: The physician value-based modifier program is coming soon. What do hospitalists need to keep in mind about this program?

Dr. Torcson: If hospitalists are part of a group of greater than 100 providers, they are under a deadline of October 2013 to establish how they’re going to participate in this program, which will impact their reimbursement starting in 2015. This is something we’ve seen coming down the pike for a number of years. It’s important to remember that the Centers for Medicare and Medicaid Services has put only 1% of our Medicare allowable charges at risk with this pay-for-performance program. And for right now it’s only going to apply to large groups of greater than 100 providers.

The reporting period for the quality measures that will be used in this first iteration is 2013 for the payment adjustment that will occur in 2015. For the rest of us in groups less than 100, the performance period is probably going to be 2014 or 2015 for the payment adjustments beginning in 2017. It’s a small amount of money at risk for right now and it only applies to groups of greater than 100 providers. But definitely stay tuned.

HN: Do you have any tips for how to make quality reporting programs like PQRS less onerous for hospitalists?

Dr. Torcson: Hospitalists should try to take off their clinical hats and even their quality improvement hats and think in terms of practice management. For now, PQRS is voluntary, pay-for-reporting only. So the focus for now is getting your reporting infrastructure in place and that is tied to how you do your billing. It’s a matter of doing the administrative work to see how you submit your claims to Medicare and getting used to reporting the quality data codes, which are part of the PQRS, to those billing codes.

For PQRS, you only have to choose three performance measures. The PQRS has over 260 measures in the program and only 10 are really applicable to hospitalists. You don’t have to hit a home run. Just choose the three measures and figure out from a practice management standpoint how you’re going to attach the quality data codes to your billing codes to get in the reporting game. That’s the best starting point.

HN: Do you think we’ll ever see a payment system based completely on quality rather than volume?

Dr. Torcson: The U.S. health care system is going to be doing a lot of experimentation with alternative payment models. A driving force is to shift financial risk from insurance plans and other payers to providers. That’s going to happen in various payment models like bundling or capitation or the accountable care shared savings methodology.

Pay for performance isn’t necessarily the key to improving care, and regulating change doesn’t seem to work either. What we hope is going to happen is that we’re going to figure out better ways to manage chronic illness and to perform care coordination for the 5% of the population that accounts for 50% of the health care resources.

Looking forward, I think that success for an individual hospitalist is really going to be achieved by aligning with the hospital-level performance agenda. Don’t just think in terms of the individual physician and how you’re going to perform, but really think at the system level.

For hospitalists, in particular, we have a great opportunity through alignment with the hospital-level agenda to really make a difference in terms of how we improve the quality of care and are accountable for costs.

Dr. Patrick J. Torcson has always been passionate about caring for the sickest patients and about ensuring the highest quality of care. So when he read Dr. Bob Wachter’s article in JAMA in 2002 showing that the movement to the hospitalist model was saving money without sacrificing quality or patient satisfaction, it led him to make the jump to become a full-time hospitalist (JAMA 2002;287:487-94).

Dr. Torcson established the hospital medicine program at St. Tammany Parish Hospital in Covington, La., in 2005, and still runs the program today. He’s also involved in the public policy and performance measurement committees at the Society of Hospital Medicine and serves as the SHM representative to the American Medical Association’s Physician Consortium for Performance Improvement, efforts aimed at ensuring that quality reporting programs are fair and relevant.

Courtesy St. Tammany Parish Hospital

In an interview with Hospitalist News, Dr. Torcson shared his thoughts on the current quality reporting programs and the ones coming down the pike.

Hospitalist News: Physicians are doing more quality reporting now than ever before, do you think this leads to improved care?

Dr. Torcson: The evidence is mixed as to whether quality reporting and pay for performance actually improve outcomes. It’s important at the outset to distinguish between hospital-level reporting and pay for performance, and physician-level reporting and pay for performance. On the hospital side, we do actually have some results mainly from Medicare’s Hospital Quality Improvement Demonstration Project that showed that when you do public reporting, like on the Hospital Compare website, and you throw some money at the hospitals, that you will get improved quality as determined by adherence to the various performance measures.

On the physician side, there really isn’t any strong evidence showing that paying physicians on a differential basis actually improves quality. It’s hard to have good objective studies of that, but the ones that we have so far, mainly on the outpatient side, really do not show a clear distinction between quality reporting and pay for performance and actually improving quality of care. The lesson there is that maybe trying to do individual-level accountability for what really is systemic care may not work. But clearly we have to do something. We know that the U.S. health care system has tremendous variability in quality and unsustainable costs, so something has to be done to drive a performance agenda to fix this problem.

HN: How relevant are programs like Medicare’s Physician Quality Reporting System (PQRS) to hospitalists?

Dr. Torcson: In some respects it has to be relevant because hospitalists now provide more inpatient care than any other medical specialty. We know that hospitalized patients are the sickest and use the most resources. So performance improvement and performance accountability has to be relevant for hospitalists because of the importance of what we do.

That being said, the PQRS program as it’s currently designed has few relevant performance measures for hospitalists. Most of it was designed around an outpatient focus with that traditional model of doctors in the office also taking care of hospital patients and wasn’t geared toward the model that we have now where most inpatient care is provided by hospitalists. And the actual platform for how the performance reporting is done is not very easy for hospitalists to work with because we rely mainly on hospital-level billing systems to report data.

HN: The physician value-based modifier program is coming soon. What do hospitalists need to keep in mind about this program?

Dr. Torcson: If hospitalists are part of a group of greater than 100 providers, they are under a deadline of October 2013 to establish how they’re going to participate in this program, which will impact their reimbursement starting in 2015. This is something we’ve seen coming down the pike for a number of years. It’s important to remember that the Centers for Medicare and Medicaid Services has put only 1% of our Medicare allowable charges at risk with this pay-for-performance program. And for right now it’s only going to apply to large groups of greater than 100 providers.

The reporting period for the quality measures that will be used in this first iteration is 2013 for the payment adjustment that will occur in 2015. For the rest of us in groups less than 100, the performance period is probably going to be 2014 or 2015 for the payment adjustments beginning in 2017. It’s a small amount of money at risk for right now and it only applies to groups of greater than 100 providers. But definitely stay tuned.

HN: Do you have any tips for how to make quality reporting programs like PQRS less onerous for hospitalists?

Dr. Torcson: Hospitalists should try to take off their clinical hats and even their quality improvement hats and think in terms of practice management. For now, PQRS is voluntary, pay-for-reporting only. So the focus for now is getting your reporting infrastructure in place and that is tied to how you do your billing. It’s a matter of doing the administrative work to see how you submit your claims to Medicare and getting used to reporting the quality data codes, which are part of the PQRS, to those billing codes.

For PQRS, you only have to choose three performance measures. The PQRS has over 260 measures in the program and only 10 are really applicable to hospitalists. You don’t have to hit a home run. Just choose the three measures and figure out from a practice management standpoint how you’re going to attach the quality data codes to your billing codes to get in the reporting game. That’s the best starting point.

HN: Do you think we’ll ever see a payment system based completely on quality rather than volume?

Dr. Torcson: The U.S. health care system is going to be doing a lot of experimentation with alternative payment models. A driving force is to shift financial risk from insurance plans and other payers to providers. That’s going to happen in various payment models like bundling or capitation or the accountable care shared savings methodology.

Pay for performance isn’t necessarily the key to improving care, and regulating change doesn’t seem to work either. What we hope is going to happen is that we’re going to figure out better ways to manage chronic illness and to perform care coordination for the 5% of the population that accounts for 50% of the health care resources.

Looking forward, I think that success for an individual hospitalist is really going to be achieved by aligning with the hospital-level performance agenda. Don’t just think in terms of the individual physician and how you’re going to perform, but really think at the system level.

For hospitalists, in particular, we have a great opportunity through alignment with the hospital-level agenda to really make a difference in terms of how we improve the quality of care and are accountable for costs.