Accountability, front and center

Mary Stevens, Editor Image source: TriMed Media Group

Responsibility and accountability are a couple of buzzwords that are working their way into the general healthcare discussion more and more frequently. As the country looks for pay-for-performance care models that reward high-quality care, not high patient volumes, accountability and defined responsibility are part of the plans.

Passage of reform may act as a catalyst that brings together caregivers and organizations in accountable care organizations, patient-centered medical home programs, telehealth and other efforts—all of which will require defined responsibilities of patients as well as clinicians, and standardized practices that can drive accountability across the continuum of care.

During a recent webinar about the future of reformed healthcare, Lisa Bielamowicz, MD, Managing Director, Advisory Board Company; and Scott Weingarten, MD, President and CEO Zynx Health, cited several organizations that have used clinical decision support to standardize practice and have motivated clinicians to improve the quality of the care they deliver while reducing per-patient costs. Their point is well taken: As ACOs, patient-centered medical homes, population-based patient care and other frameworks evolve, accountability and responsibility have to be ongoing, adaptable practices.

But can much does a focus on accountability actaully improve healthcare? It depends, according to a recent RAND study of P4P programs for hospitals and physicians. The study showed that P4P prgrams have bettered the quality of care delivered, but not by much. The size and nature of the incentive is an important factor in the overall success of the program, the study found. For example, in many healthcare P4P programs, the potential financial rewards represent a small percentage of physicians’ overall pay and, as a result, may not serve as a strong incentive.

The study found that a strong knowledge base about the drivers of performance helped create consensus on who should be held accountable for what. However, there were often differences of opinion about the desirability and general contours of P4P programs, and programs are often created in spite of a lack of consensus about key issues.

On the subject of accountability, a recent analysis suggests “sorry” is a powerful word. Establishing a program that mandates full disclosure and compensation to patients with regard to medical errors may potentially reduce malpractice claims, according to the retrospective analysis published in the Aug. 17 edition of the Annals of Internal Medicine.

Since 2001, the University of Michigan Health System (UMHS) has fully disclosed and offered compensation to patients for medical errors. Under this model, UMHS has claimed to proactively look for medical errors, fully disclose found errors to patients and offer compensation when at fault. When researchers compared liability claims and costs before and after implementation of the UMHS disclosure-with-offer program, they found the average monthly rate of new claims decreased from 7.03 to 4.52 per 100,000 patient encounters. Likewise, the average monthly rate of lawsuits decreased from 2.13 to 0.75 per 100,000 patient encounters. Clearly, accountability can pay off.

 

Mary Stevens, editor

mstevens@trimedmedia.com