Joshua Bershad, M.D.How were the 50 physicians chosen to participate in the pilot?We wanted at least a 2-1 economic or quality return on the investment we were making in the system. So we looked at which physicians had the most opportunity to improve or who were the most influential among peers. The goal was for this not to be a punitive process; it was meant to make them aware of performance trends.How did you unseat the common physician rationale that their patients are sicker than others that were benchmarked?Most systems that look at physicians’ performance on economic and quality, look at physicians compared to others. And that leads to the argument, ‘well we don’t have the same patients.’ However, Crimson looks at the patients you take care of versus by patients taken care of by anyone in the control group. So it’s looking at patient to patient, instead of physician to physician. So the statement that I started all these meetings with physicians is, ‘your patients have a longer length of stay than those patients with the same severity of disease and the same disease processes taken care of by other physicians.’It’s never the tool that gets you the results; it’s the partnering of the tool and the process. We took a very disciplined approach. [When I would meet with the physician] I would try to pull out a [patient] case to find an example to illustrate the points of where this physician could improve. So we used specific patient examples to get performance to change.How does this help you on your road to meaningful use?This isn’t truly part of the meaningful use criteria. But I think where this works is [to start] a discussion around info sharing to be the fundamentals behind accountable care and looking at outcomes. When you look at outcomes you need data and a system and everyone to have easy access to the outcome information. Crimson updates every month and is accessible over the Web, so you can look at it anywhere you want, any time you want.What were the challenges during this project?This is a very time-intensive process, as with any type of cultural change. It’s just a matter of coordinating, tracking, measuring, and project managing something like this to keep it moving. It’s one-on-one meetings and discussions about practice. Yesterday, I got a call from one of the physicians we work with who said, ‘hey I have a patient that’s in the hospital. The patient had a unique clinical condition, and I know that they’re going to be in here for longer than I expect. I know that my numbers didn’t look as good as it should have last month. What should I do?’ First, the fact that he saw the number we sent him, second, he recognized the challenge, and three he reached out for help. That’s a cultural change that occurred, and six or seven months ago they wouldn’t have cared at all. They would have cared about the eventual outcome and the patient, but they wouldn’t have cared on a performance basis.