If a Discipline Falls in an Industry, Does it Make a Sound? by Pat Conrad MD

“The American Board of Family Medicine (ABFM) launches the start of a Family Medicine Registry with a study called the Trial of Aggregate Data Exchange for Maintenance of certification and Raising Quality (TRADEMaRQ) study.”  Exciting, huh?

• Subsidized by $7 million of taxpayer dollars. (Why?)
• Supposed to make MOC easier and more meaningful (Simple.  Make it 100% pass, and free).

Phase I will be for automatic data collection and quality improvement.  A research team will give feedback to the physician, and study whether said feedback affects the Self-Assessment Modules and Practice Performance Modules physicians choose, and if it improves quality (We’ll tell you what to do, then see if you do it).  And they will market it all as “helping patients” whose doctors have been thusly corrected.  The TRADEMaRQ’ers want to find out:

•     If the collected data can be easily shared with certifying boards (oh great!)
•     Whether those studied will try to be like their peers (it’s safer in the herd)
•     Whether seeing this feedback will improve future performance (that depends on whether you’re paying me)

Phase II is the daiquiri phase, which sounds more fun.  No, scratch that.  It’s the Data Abstraction and Intelligence Quality Engine for Research and Improvement (DAIQUERI) phase.  This is all supposed to hoover data out of your EHR’s to produce – you guessed it – more quality.  But this sentence can better explain:  “DAIQUERI is being developed by FIGMD whose tools are currently being used by other physicians to meet PQRS reporting needs for thousands of physicians.”

<< And here I have to interrupt this broadcast – reading the site linked, it said at the top “2019”, but I see that this article was from 2015.  So it may have been bypassed by other more scintillating developments, and/or we may have already made fun of this.  Oh well… So now I will speak of it in the past tense.  >>

The ABFM supported (claimed to) the first 6,000 family physicians to enroll, and sought to keep costs “far lower than EHR vendors charge for data analytics and exchange tools, and lower than the average mobile phone bill.” (Did they?  I don’t know.  Do you care, anyway?)

“ABFM will not engage in any data-sharing relationships that put family physician data at risk, and will give diplomates control over who has access to their data, and where it is sent.”  Hmm, we’ll just leave that there…

This promo told about the “benefit of the registry is that it will allow the ABFM to assess the benefits of various QI efforts.”   In 2015 it claimed, “about one-half of family physicians do an approved MOC quality improvement project designed by someone other than the ABFM” (Hehehe, and them boys didn’t like the competition).  This next advisory, admittedly 3 years back, still rings true:  “We currently have no way of knowing whether those projects improve quality.  The registry will eventually allow you to more reliably choose QI tools that make a difference.”

The TRADEMaRQ’rs and DAIQUERI-mixers also touted this stuff to “provide leadership in developing more meaningful primary care measures.”  Do you think they succeeded?

“This leadership will be important as payers shift to value-based payments. In building out the registry, we recognize that there are hundreds of primary care measures, but no strategy for understanding which are most valuable”(Because mere doctors wouldn’t know, and we need to wait for the payers to tell us).  The ABFM assured us that they would they recognized that measurement fatigue was a problem (so more measuring was expected to help).  “The family medicine registry will strengthen the specialty’s position in negotiations with measure developers and payers.”  It must have been a tremendous success, given they increased pay and reduced hassle that spurred the resurgence in primary care over the past 3 years.

Another couple paragraphs rattled on about how the ABFM regarded the registry as an “investment” in family medicine, and how it was willing to triple funding to support aligning the registry and new MOC tools with practice transformation, allowing a more effective shift into value-based payments.  I wonder if this happened?  Does anybody care?

Then we got the sum-up on developing new geographic and social determinant tools in order to better provide community and population health.  The problem I have is that it suggested a presumption that ALL family medicine should be really interested in this stuff and should collect and transmit data accordingly:  “Value-based payments mean greater accountability for population health.”  I guess if that was your boat, then I hope you set sail, but I’m betting most family docs with more immediate fish to fry were being dragged into worrying about this via threats of reduced payments.  The Population Health Assessment Tool (PHAsT) was nothing if not ironically named.

“PHAsT may help you recognize that most of your patients with diabetes and hemoglobin A_1c above 9.0 live in neighborhoods that are unsafe for exercise and lack healthy food sources. You could partner with a local YMCA, mall or armory to develop an indoor walking club, diabetes peer-support group, or farmers market—or all 3. We know from experience that family physicians in community health centers have used these tools in clever ways, and now want all family physicians to have the same opportunity, especially when payments may soon be based on population health outcomes.”

So to conclude, three years ago the ABFM started a registry and tools to improve quality data gathering for integration with a more meaningful MOC, to transform your practices and deliver more value-based payment along with better community health.

Has anyone noticed?

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