Managed Care - April 2008 - (Page 45) MC: A study came out recently that found public reporting of physician quality has not had much effect on quality and safety. BAGLEY: It’s too early in this whole process. As we get farther down the line and physicians begin to see what they deem credible data, they will move and change. What we find repeatedly is that when physicians get electronic medical records up and running in their practices, they start to get their own data back and they realize how they are actually doing when it comes to taking care of patients. One physician at a meeting I attended recently said that when his practice began using an EMR and a report showed how poorly they were doing with their diabetics, they changed their systems and processes the next day. As soon as they had data from their own patients that they put in the computer themselves, there was no longer any question about the credibility of the data. They felt compelled to do something. So measuring is fundamental. Once physicians see credible data, they are extremely competitive. MC: It’s difficult to set up the systems that are required for the medical home, quality improvement, and pay for performance. What are the roles of various stakeholders in helping practices do this? BAGLEY: As a membership organization, the AAFP believes it’s unrealistic to advocate for somebody else to pay for all of this. We are therefore trying to help members make the right choices so that they don’t waste their resources putting in the wrong systems and technologies. We have a major effort around medical records. We identify the functionality and the systems that do a good job and companies that are reliable and efficient. MC: Is it not true that interoperability standards are still not agreed on? BAGLEY: We’ve done a lot of work on that. Our organization has promoted the Continuity of Care Record as an interoperability standard for the last three or four years. This would be a way for disparate computer systems to talk to each other about a discreet packet of clinical information about a patient. It’s an XML file that you can open up with any browser, and any EMR would be able to convert it to its own data array. So we’re deeply committed to that as well. MC: Physicians often complain that they cannot afford to install electronic medical records. BAGLEY: I always counter that they can’t afford not to. They don’t realize the efficiencies that are obtainable with electronic medical records when they are looking at the price tag, so they keep slogging along for years in an inefficient system. In Latham, where I practiced, we put in an electronic medical record system about three years before I left. We realized efficiencies we didn’t even expect. For 25 years, we had struggled with our phone system. We were never able to answer the phone without a lot of dropped calls and busy signals. When we finally got the electronic medical records system up and running, all of a sudden we were answering our phones well with fewer people. We also went from having six people in the medical records room to having two. Those things are very hard to anticipate. The efficiency, the consistency, the ability to have the information you need to make good decisions — it’s so much better with electronic medical records that there’s no excuse for not having them. MC: Are you encouraged? BAGLEY: I see slow but steady progress. We did a survey just a couple of months ago that found that 37 percent of family medicine doctors, our active members, have EMRs installed. Another 13 percent are in the process of implementation, and 25 percent more are shopping. MC: What projects are you excited about when you look ahead to the next year or so? BAGLEY: We worked with the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association to help the NCQA become an adjudicator for the medical home concept. They launched the new program in January. The NCQA has had physician recognition programs for a number of years now, but we’ve modified those tools to be a gauge of a practice’s success in creating a medical home. It goes through a long list of processes and systems that really should be in place in the office, such as registries, referral and laboratory test tracking, and collecting data on the practice’s top three diagnoses and trying to improve them. In the past everybody has just winged it. We want health plans to recognize and compensate physicians for the added value of the medical home. This way, the NCQA can designate which practices provide these services, so health plans won’t have to adjudicate that. MC APRIL 2008 / MANAGED CARE 45
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