Jump to content

Great article on OPPE.


Recommended Posts

This was interesting to read...

 

http://www.beckershospitalreview.com/healthcare-blog/close-the-hospital-fire-the-physician-the-case-for-harshness-in-healthcare.html

 

And finally, Dr. Cosgrove talked about the way Cleveland Clinic treats its 3,200 physicians. "As far as I know, we're the only hospital system in the country that has one-year contracts and annual professional reviews for the physicians," he said.

 

The system is serious about both: Last year 8,000 man hours were spent on physicians' professional reviews, and some one-year contracts were not renewed. "We expect productivity, and if somebody is not producing in whatever their obligation to the organization is, they may not stay with us," said Dr. Cosgrove. Cleveland Clinic also force ranks physicians in a transparent way, so everybody knows who is best, average and below average. "We force rank them into top 10 percent (who we should celebrate), the middle and the bottom, who we should either move up or out."

 

Move up or get out; get better or get gone: That's the type of language healthcare needs more of. For all the talk about patient-centered care, compassion and "first do no harm," this industry has a tendency to exert extra compassion on itself rather than functioning more visibly like a business driven by forces like any other.

 

The thoughts mentioned above aren't pretty, but bright minds are talking about them with urgency and excitement. Closing hospitals, firing doctors, hanging up on calls for donations: It sounds reprehensible, except it's not at all. It's the new reality. It used to feel crass to talk about healthcare with business lexicon, but it's getting easier and easier by the day. This isn't good news to hospitals that have been asleep at the wheel, masking their faults with do-gooder hyperbole about their missions. People may not have much patience for that fluff too much longer.

 

I think we're going to see a lot more of this all across healthcare as contractionary effects are more fully felt.

Link to comment
Share on other sites

  • Moderator

there are some places where this is probably overdue. I know lots of  docs who are essentially "tenured" at their jobs and could only be fired for gross negligence. they get away with treating PAs/NPsRNs/Patients like crap and many practice questionable medicine 10+ years out of date.

at one of my jobs they post productivity #s with names for all to see. only rarely(and only in the case of PAs...) do these production #s result in folks losing jobs.

wow, this is a much more intense thread than I thought when I originally saw the title and thought it might be about this:

http://en.wikipedia.org/wiki/Opie_Taylor

Link to comment
Share on other sites

This article is sensationalist BS.

It starts out with a valid statement concerning patient injury in healthcare. Then proceeds to lay blame at the feet of your local hospital whom does not have the resources in comparison to a large health system in the midwest whose CEO seems intent on making inflammatory marks rather than focusing on the overall improvement of healthcare.

Add to that the qualifications of the staff at this magazine, none whom holds any healthcare associated degree and likely has not provided any patient care in any form whatsoever.

Shortsighted statements and lack of insight into a tremendously complicated industry summed up in a one page article solution from an individual without legitimate experience in the industry she covers as a journalist.

Nothing but garbage.

G Brothers PA-C

Link to comment
Share on other sites

Let us not forget, though, that a high quality provider will have not only production numbers which are good but will have high patient satisfaction scores, practice gold standard medicine to whatever extent possible, and will have few complications rates/adverse event rates which are on part with the patient population they serve and their peers in the same population.

 

I hate the idea of pay for performance in that there are absolutely intangible factors that effect it.  When I worked on the reservation my Pt's A1Cs were not to goal more often than the were on target.  Same with lipid and HTN parameters.  I'd like to think it's not because I was/am a crappy provider, but I was a new grad at the time and all of my colleagues dumped the noncompliant patients on me (this is a standard practice at that clinic, unfortunately, as the noncompliant people would no show so many times they'd get fired from all the other providers).  So you have to rate a provider in that situation based on his/her patient population and some other intangible goal.  With the advent of ACOs, we're looking at poor reimbursement on a per patient basis if the patient doesn't meet their pre-defined standards of care - but this is patient specific and may have no reflection on the provider's care whatsoever.

 

We need something beyond production as a guide, too - shady providers can produce like none-other while patient care suffers and they get shafted and vice versa.  One of our NPs who is a fantastic provider and diabetes specialist gets the short end of the stick on this because she has long appointments to counsel DM patients at length about how to manage their condition.  2 no shows/day and her numbers take a huge hit.  I work in UC and my production is great, but am I really providing the care that these patients need?  Treat-em-and-street-em is not always what is best.

 

What we need is something like what Mayo does, where everyone from the janitor to the MA and nurse to the PAs peers and their collaboration physician's have a say in the evaluation.  I think they call it a "360 degree evaluation."  While healthgrades.com may be a bit of a farce, I still check it every now and again.  Granted, the folks who say something about you on a random website anonymously will likely have nothing good to say, it's still a reflection on how we are perceived. 

 

There is a lot to this and while I think that having some objective standard to which we can be held, healthcare is unfortunately so subjective that obtaining something by which we can all be evaluated fairly may not be a reasonable goal. 

 

Food for thought.

Link to comment
Share on other sites

Productivity is a great measure of a clinician

 

just read this article to understand

 

http://www.propublica.org/article/obstetricians-among-top-billers-for-group-psychotherapy-in-Illinois

 

Said tongue-in-cheek, I hope. 

 

The article is about physicians who defraud Medicare and Medicaid, most of whom could not be contacted to comment on their activities. 

Link to comment
Share on other sites

There is more fraud than we will ever know. I know personally I saw quite a few incidents while working at HHSC. Hardly anyone who works in healthcare rarely learns that much about the business side of the work they will do. Medical students as well as PA students often assume large personal debts to finance their education and training. In efforts to repay these loans may push new doctors/PAs toward unacceptable financial tactics when they begin to practice. Common sense suggests that greediness plays a role in billing scams.

Link to comment
Share on other sites

The point is, whether we like this or not, these changes are coming. Healthcare is going to be treated like other professions. A lawyer is not productive and doesn't bring enough revenue in, he doesn't make partner, and then eventually, will be let go.

 

Healthcare providers for a long time have been insulated from this sort of competition. It needs to be there. No one is suggesting that average performers will be held accountable, but those that deviate too far below the mean will struggle.

 

Part of what we are seeing is massive consolidation in an effort to combat deflationary pressures in the market. EVERY healthcare organization is concerned with productivity.

 

Mayo, since a poster brought it up, does use 360 degree feedback, and does get input from a variety of your co-workers. This is changing though. Some departments are now using a formula that evaluates productivity, patient satisfaction, academic production (measured in papers published, grants, etc.), as well as national and/or international reputation. This will be a massive shift.

 

I'm not posting this to suggest anything beyond the fact that these sort of more focused OPPE reviews, short term contracts, and a greater gamble on job security are all happening.

 

One of my mentors and colleagues is on the American Hospital Association BOD. He and I discussed this very article, and he mentioned that he agreed that we have too many hospital beds. There will be hospital closures in the future, and further consolidation. A lot of the things discussed in this article, while being hyperbolic, and being poorly written as noted above, are being hotly debated and discussed among healthcare executives and hospital administrators across the country.

Link to comment
Share on other sites

The point is, whether we like this or not, these changes are coming. Healthcare is going to be treated like other professions. A lawyer is not productive and doesn't bring enough revenue in, he doesn't make partner, and then eventually, will be let go.

 

Healthcare providers for a long time have been insulated from this sort of competition. It needs to be there. No one is suggesting that average performers will be held accountable, but those that deviate too far below the mean will struggle.

 

Part of what we are seeing is massive consolidation in an effort to combat deflationary pressures in the market. EVERY healthcare organization is concerned with productivity.

 

Mayo, since a poster brought it up, does use 360 degree feedback, and does get input from a variety of your co-workers. This is changing though. Some departments are now using a formula that evaluates productivity, patient satisfaction, academic production (measured in papers published, grants, etc.), as well as national and/or international reputation. This will be a massive shift.

 

I'm not posting this to suggest anything beyond the fact that these sort of more focused OPPE reviews, short term contracts, and a greater gamble on job security are all happening.

 

One of my mentors and colleagues is on the American Hospital Association BOD. He and I discussed this very article, and he mentioned that he agreed that we have too many hospital beds. There will be hospital closures in the future, and further consolidation. A lot of the things discussed in this article, while being hyperbolic, and being poorly written as noted above, are being hotly debated and discussed among healthcare executives and hospital administrators across the country.

We are also watching healthcare reinvent the wheel. You should know enough about vitality curves or forced ranking to know that most companies have abandoned them or modified them. At their worst they are tremendously destructive to morale, encourage sabotage and encourage employees with input to the hiring process to promote mediocre hires. If we are moving to a collaborative model then forced ranking is the last thing we want. 

Link to comment
Share on other sites

We are also watching healthcare reinvent the wheel. You should know enough about vitality curves or forced ranking to know that most companies have abandoned them or modified them. At their worst they are tremendously destructive to morale, encourage sabotage and encourage employees with input to the hiring process to promote mediocre hires. If we are moving to a collaborative model then forced ranking is the last thing we want. 

 

 

Yep, Jack Welch so infamously used it at GE. I agree that team building is more important, as the other problem with vitality curves is that they promote perverse incentives in the top performers, altering the curve.

 

That's sort of the point. This is going on...we need to be aware of it, and we need to be involved and have a seat at the table with these discussions taking place.

 

Haven't seen you since the Academy. Trust you are doing well?

Link to comment
Share on other sites

This article is sensationalist BS.

It starts out with a valid statement concerning patient injury in healthcare. Then proceeds to lay blame at the feet of your local hospital whom does not have the resources in comparison to a large health system in the midwest whose CEO seems intent on making inflammatory marks rather than focusing on the overall improvement of healthcare.

Add to that the qualifications of the staff at this magazine, none whom holds any healthcare associated degree and likely has not provided any patient care in any form whatsoever.

Shortsighted statements and lack of insight into a tremendously complicated industry summed up in a one page article solution from an individual without legitimate experience in the industry she covers as a journalist.

Nothing but garbage.

G Brothers PA-C

 

Agree with the sensationalism re: the hospital closures part of the article.

Toby Cosgrove's comments about how we manage lower tier programs outside his almighty sphere is drenched in hubris. CC's approach to direct relationships w/ large businesses is innovative, but we can't realistically ship everyone there for their surgery/etc.

 

 

The author walked back a bit in a follow up piece. Read the quotes from Dr. Sager.

http://www.beckershospitalreview.com/healthcare-blog/close-hospitals-not-so-fast.html

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More