Here’s one from the Annals of Family Medicine Research and brought to you by our good friends at the AAFP. It’s called Use Field-tested Tactics to Improve Care, Reduce Costs and I just bet by reading the title your bullsh$t detector is going off full blast.
The article first points out why MIPS has failed and “that ongoing programs aimed at helping physicians improve care quality and lower spending have failed to show consistent, across-the-board progress in these areas.” Do they come up with an answer? Yes. Is it the right one? No. The researchers/experts did the following:
- Thus, they set out to look at a small national sample of primary care practice sites to “reveal attributes of primary care delivery associated with high value.”
- After developing a ranking process for quality that was based on 41 measures, researchers visited 12 high-value primary care office sites and four average-value sites between May 2013 and June 2014.
- Site visits lasted eight hours and were conducted by a primary care physician experienced in practice assessment and a nonphysician qualitative researcher. Visiting teams conducted interviews including “open-ended questions aimed at identifying attributes that interviewees felt might account for their practice site ranking favorably.”
Let’s point out the problems with this. They use a small sample. They find practices of high value, which really seems pretty subjective to me. They develop a ranking process for quality based on 41 measures. Once again they use “quality” as their standard and that term is undefinable. It’s a moving target and means one thing to some people and other things to other people or patients. They then give their findings which are:
- expanded access including same-day appointments, walk-in availability and extended evening and weekend hours;
- shared decision-making and advance care planning;
- patient feedback — positive and negative;
- comprehensive primary care where physicians practice within the full scope of their expertise;
- upshifted staff roles that allow physicians to devote more time to the most complex patients;
- shared workspaces where care teams can communicate face-to-face; and
- low practice overhead costs for office space and equipment.
All this all screams DPC but with tons more overhead and headache. Anyway, here are the buzzwords and soundbites they go on to write in this AAFP piece:
- care traffic control
- represents an advantaged platform for care coordination
- ease cognitive burden
- signals the usefulness of echoing within a practice external efforts to reward value rather than volume
I don’t even know what this means. The only comment left on the website was perfect:
“Great article for a healthcare widgets and wonk person. I wonder what the results would look like if designed by Doctors and patients instead of academicians. Many of the conclusions seem strained and preconceived to fit a mold that was already cast….”
Exactly. Or, family doctors could do Direct Primary Care and all this is solved.