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Quality Health Care starts with Quality Practitioners

January 26, 2018

Bringing provider transparency into the quality measures equation is an overlooked but vital step in the focused effort to assure quality health care while controlling costs.

Dr. Allen Weiss, president and CEO of NHC Healthcare System, Naples, FL said in his Guest Commentary on Modern Healthcare that the U.S. spends 17.8%—the highest ratio of GDP on health care—“…yet consistently ranks toward the bottom in health outcomes among the 11 most-developed nations. Better performance equates to fewer complications, decreased waste and lower costs. All of these attributes contribute to a healthier America and the ability to transfer resources to other vital endeavors such as education, infrastructure, safety and environmental protection.”

While the end game of health care should be safety, prevention, quality of life, outcomes and the many measures we focus on for chronic illness, it has only been in the past 15 years that attention is turned to wellness as a factor in the quality health care and cost containment conversations.

I have been so happy to be part of the change, but as we have all focused on patient outcomes, quality measures and transparency, it occurs to me that along the way we missed a significant component. We continue to quantify provider quality through outcomes. How are we expecting good results to come out of providers when there are minimal checkpoints and ‘lite’ requirements in place to screen, validate, verify and monitor the health care provider population?

With best practices in place that vet providers based on identity verification, license status, credentials, privileging, peer reviews and ongoing monitoring, the state hoppers, license shifters, elder abusers, sex offenders and those excluded from practicing medicine would not be in the system in the first place, or if they already are, they would be swiftly removed from the system.

Then and only then would outcomes be true outcomes when not skewed by those who should not be practicing medicine at all. And next, the waste, fraud and abuse loss derived from paying out first and then financing the recovery efforts to at best recover a fraction of the original outlay would be reduced.

Technology has advanced to deliver historical and current data on providers in real time, where in the past, especially going back to the paper file systems of yesteryears, it was very difficult to spot state hoppers and license shifters, billing schemes and fraud. It’s time to protect patients and ensure our health care dollars are being spent on quality care by eliminating those practitioners who cause harm and jack up the cost of health care through fraud and waste costing billions of dollars annually—10% of the $3.2 trillion annual budget in 2016.

The guidelines outline, at a minimum, what data we should be searching to verify the quality of providers before we allow them to be part of our systems. Times have changed, technology has evolved, and information is far more in-depth such that we can identify and proactively understand exactly who our provider candidates are prior to granting them permission into our care stream.

As an industry, it’s time to go beyond the suggested minimums while hedging bets on penalties and deferring the risk to patients. Full transparency at the individual provider level is accessible, and I think we need that granular, real-time level of transparency to ensure quality, control costs and reduce risk.

Dr. Weiss continues in his commentary, “All members of the healthcare community have an obligation to be more responsive to their customers. Sharing best practices among ourselves, just as we are now sharing statistically accurate knowledge, will help everyone achieve better performance and outcomes. Although the process may be uncomfortable initially, in the long run having transparency as a stimulus for improvement will benefit every stakeholder in the industry…”

The health care consumer entrusts the system entirely without anything more than word of mouth, a framed license on the wall and if you are in the know, a star rating system and the CMS Hospital Compare tool. Through the CMS star system, a patient can compare hospitals on seven primary categories: mortality, safety, re-admission, patient experience, effectiveness of care, and timeliness of care. This is a good start. Hospitals are accountable but the stars and compare tool do not provide current transparency on individual providers. As an industry, I strongly believe that each of us are charged to do our part to raise the bar and access the full scope of what technology offers—the ability to screen, verify and monitor each and every provider against the best data available in real time.

As patients, we are expected to believe that a doctor took a sacred oath and is going to be a good doctor. What we missed in this assumption is the very important part of fully vetting the provider—making certain without a doubt that each provider is licensed, qualified and board certified, eligible to prescribe, without criminal history, and demonstrates the mission of ethical health care across all practices and jurisdictions of their history.

Technology and cloud-accessed shared data facilitates an enhanced value to our cumulative work focused on quality. By leveraging the technology and data that is readily available, we can now include a full and transparent view of each provider and take action accordingly to exclude them appropriately and swiftly with the mission of improving quality health care delivery to patients and reducing costs.

About Jan Smith Reed
Jan Smith Reed

Jan Smith Reed has dedicated her career to developing and implementing strategies to insure the health care industry takes a holistic view, as a best practice, to protect the patient,  improve outcomes, bolster the business and control costs.

She has a broad swath of expertise as a business-savvy executive with proven results in matrix management. She is well established in both commercial and government health plan management including self-funded, fully insured, managed care, MAPD, PDP and Medicaid.

She is quick to discern business needs while creating and communicating a vision of desired outcomes through building and motivating cross-functional teams to resolve problems and ensure successful execution.

Ms. Reed is revered as an effective communicator and is tapped for national media interviews, marketing content, market perceptions, and strategies.

As Vice President  at Verisys Corporation, Ms. Reed applies her skills and talents to create and implement solutions for her clients from a patient-first perspective with an eye on mitigating risk through best in class solutions to eliminate fraud, waste and abuse. 

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