Healthcare Analytics

Evaluate Performance with Physician Quality Measures

The Only Constant Is Change

In addition to the shift toward value-based reimbursement, a variety of market forces are causing rapid changes within the healthcare industry. These include:

  • Convergence and integration
    • As employers, health plans, and providers come together, the value of contracts is growing, but the number of potential customers is shrinking
  • Likelihood of disruptive entry
    • Urgent care and walk-in pharmacy clinics, along with wearable and other internet-enabled health technologies, are changing healthcare at an astonishing rate
  • Uncertainty in the marketplace
    • The implications of the Affordable Care Act and the transition to ICD-10 will continue to reveal themselves in the coming years

As the industry moves to place a greater emphasis on value to the patient, the physician quality measures used to evaluate practitioner engagement and performance are evolving in kind.

6 Physician Quality Measures of OPPE

The goal of Ongoing Practitioner Performance Evaluations (OPPE) is to provide data on performance for all practitioners in a timely, ongoing manner in order to identify issues and ultimately improve performance. OPPE stresses 6 core competencies:

  • Patient Care
    • Provide compassionate, appropriate, and effective care
    • Promote health, prevention and treatment of disease, as well as end-of-life management
  • Medical and clinical knowledge
    • Demonstrate knowledge of established and evolving biomedical, clinical, and social sciences
    • Apply this knowledge to patient care and the education of others
  • Practice-based learning and improvement
    • Use scientific evidence and methods to investigate, evaluate, and improve patient care practices.
  • Interpersonal and communication skills
    • Display interpersonal and communication skills that establish and maintain professional relationships with patients, families, and other members of healthcare teams
  • Professionalism
    • Reflect a commitment to continuous professional development and ethical practice, an understanding and sensitivity to diversity, and a responsible attitude toward patients, medicine, and society
  • Systems-based practice
    • Understand the contexts and systems in which care is provided and apply this knowledge to improve and optimize care

Best Practices for a Physician-Aligned OPPE Process

All physicians within a network should be included in OPPE, not just those with identified performance issues. A clearly defined process should address:

  • Validity: Do physician quality measures measure what they’re supposed to?
    Example: Does a secondary diagnosis that wasn’t present on admission measure complications?
  • Accuracy: Does the measure correspond to the true value?
    Example: Does a count of inpatient activity by attending physicians undercount total activities for surgeons?
  • Reliability: Will it provide the same result if it is re-counted?
    Example: Are health information coding- or case review-dependent measures reproducible?
  • Accessibility: Is the information formatted in a usable design?
    Example: Is there a dashboard for quick viewing plus the ability to do detailed analysis if needed?
  • Availability: Are physician quality measures refreshed frequently enough?
    Example: Can physicians genuinely use these measures to change their behaviors in real time?

Find out how McKesson Practitioner Evaluation™ can streamline and accelerate your physician evaluation efforts.

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