Got Incentives? A New Study Confirms the Idea that Physician Alerts Aren't Enough

April 9, 2013
The October issue of The American Journal of Managed Care included a fascinating article, "Implementation of EHR-Based Strategies to Improve outpatient CAD Care," in which a group of researchers documented how EHR-facilitated physician alerts alone aren’t enough to improve outcomes for patients with such chronic illnesses as coronary artery disease. It turns out, success requires a savvy combination of financial incentives, IT alerts, and good data analysis.

The October issue of The American Journal of Managed Care included a fascinating article, "Implementation of EHR-Based Strategies to Improve Outpatient CAD Care," by Stephen D. Persell, M.D., M.P.H., and several other physician and non-physician researchers. Dr. Persell and his team analyzed the results of a program designed for and implemented in a physician organization that was aimed at “quality improvement intervention during two time periods on four coronary artery disease [CAD] measures in four primary care practices. During the first phase,” the article’s authors noted, electronic reminders prompted physicians to order indicated medications or record contraindications and refusals (exceptions). In the second phase, physicians also received reports about their performance (including lists of patients not satisfying these measures), and financial incentives were announced.”

Importantly, the researchers found, “Physicians responded more to the combination of feedback and financial incentives than they had to electronic reminders alone.” In fact, they noted in the article, “High performance was only achieved for one of four measures and recording of exceptions rather than increases in medication prescribing accounted for most of the observed improvements.”

Studies like this are important, as they help focus attention on the many variables involved in successful performance improvement programs in patient care processes. I’m sure very few in the industry would be surprised to learn that the most effective initiatives involve some form of financial incentive; but what is interesting is to consider how effective a constellation of elements could be in so many situations.

And of course, that means that all the important stakeholder groups would need to be represented at the table whenever such initiatives are conceived and developed: the physician and other clinician leaders, representatives of front-line physicians, the IT leaders (especially CIO, CMIO, vice president of clinical informatics, etc.), and of course, the financial executives in an organization as well. And sometimes, that can be very difficult to achieve, especially in this time of swirling organizational imperatives.

Yet given how several mandatory programs under the Affordable Care Act—the value-based purchasing program, the avoidable readmissions reduction program, and the healthcare-acquired conditions reduction program—and several additional voluntary ones, including the accountable care organization and bundled-payments shared savings programs—all involve a combination of financial incentives, clinical outcomes measurement, and automation-facilitated data reporting—the logic of all this should be quite clear.

This is a time of great challenge and opportunity, but in this context, I think, exceptional opportunity, for healthcare IT leaders, as patient care organizations move forward to meet the demands of purchasers and payers in healthcare. Creating the IT foundations for performance improvement in patient care quality will be, and should be, a key element in moving towards the new healthcare. After all, when done right, performance improvement is clinician-driven. And isn’t that absolutely the best kind of process in healthcare, anyway?

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