By: Soey Park for Body1
The Minnesota state legislature recently passed a law requiring all medical practices to participate in a public ratings system starting in 2010. Clinics in Minnesota are drawing national attention for their efforts to improve their healthcare services and results through community-based collaborative reporting. If successful, this reporting system may represent a new model for evaluating care across the US.
A Minneapolis-based nonprofit called MN Community Measurement started publishing health-care results for the state’s medical groups in 2004. These public report cards are updated annually, aimed at informing patients, insurers and fellow physicians on how different clinics in Minnesota are doing. Their model looks to the cooperation of local and regional health-care providers and insurers to make performance data public, thus sparking a nationwide movement towards better patient care and management.
HOW IT BEGAN
This particular project began when major nonprofit health plans in the state decided to examine the care being given to patients diagnosed with diabetes. This was done by examining the percentage of patients who were nonsmokers, took daily aspirin, and met targets for blood pressure, blood sugar, and “bad” cholesterol. When the first set of results came out in 2004, it became clear that there was a problem. Only about 4% of patients with diabetes were reported to have achieved the targets for all five of the measures.
Ellsworth Medical Clinic for example, is a two-doctor family practice located in Ellsworth, Wis., and it started out with just 8% of its diabetes patients achieving all five goals. After this report came out however, the clinic started a new digital patient-tracking system, monitoring the MN Community Measurement gauges and others. This new system had a physician’s assistant checking on each patient every three months, and those who hadn’t come in for their testing would get a reminder in the mail.
In the past year, the clinic has also included a care coordinator to make reminder calls as well as help with any problems they might be facing. Chris Tashjian, one of the doctors from Ellsworth Medical says that the practice now has more than 30% of its diabetes patients meeting all five goals.
This new ratings system has also made an impact on the bigger physician groups, generating a new sort of ‘competitive market’. “Physicians are very competitive people,” says Linda Walling, the medical director for clinical informatics at HealthEast Care System. When Terry Murray, the director of quality management and member of an advisory board for MN Community Measurement showed the doctors at Quello Clinic the initial ratings for their practice, they were bothered. The clinic’s measures were good, but not at the top, where every doctor strives to be.
Ask your clinician about their policy on patient follow-up and care. Make sure you are satisfied with their standards and what they are offering.
Create and go over an attainable set of health goals with your doctor. Set up a follow-up meeting or phone call to remind yourself about these goals.
Understanding and asking questions are key. Do not hesitate to ask the nurse, nurse practitioner, or physician’s assistant any questions regarding any tests run, medication given/prescribed, or comments made by the doctor during the course of the appointment.
A change that seems to be occurring with the implementation of this public ratings system has been the change in the relationship between doctors and their nurses. Partly as a result of the measures, it seems that some doctors are letting nurses take bigger roles in tracking patients, making sure the blood-sugar tests are done before doctor visits, and sometimes, letting nurses go ahead and call patients back in if the doctor forgets to order tests during a visit.
The MN Community Measurement has been praised by doctors who say that it forces health plans, medical groups and employers to focus on a common set of goals. Working alongside physicians and taking their concerns into account, the organization has also improved their quality measures.
Over the years, the organization has also been able to point to some statewide improvements on the measurements it tracks. In 2008 for example, 13% of patients statewide were able to achieve the five-measure diabetes standard, which is more than triple the rate from 2004.
In this past year, MN Community Measurement has also added a new depression standard, reporting results from its first survey of patients with questions regarding the quality of care they received, including how well their doctors communicated and how courteous the office staff was.
There are limits however, to what public reporting can accomplish. Brent Elert, executive regional medical director at Fairview Medical Group, says that such public reporting can be a good motivator, but “There’s always concern about cookbook medicine…You still have to treat the individual patient, not [just do] what makes your numbers look best.” HealthEast’s Dr. Walling has also said that she has seen a few examples of a troubling new phenomenon wherein doctors are “firing” patients for not working to improve their results.