Pay For Performance: How Will It Impact Diabetic Foot Care?

By Caroline E. Fife, MD

A Closer Look At Evolving Quality Improvement

Quality improvement programs began with reviewing the “bad outcome cases” and punishing the “bad” doctors. This progressed to quality improvement “protocols” (standard protocols particularly for conditions such as myocardial infarction or pneumonia that require hospitalization) and then outpatient registries (such as for registries for preventive care like mammograms).    What defines quality healthcare? According to Terris King, who is with the Office of Clinical Standards and Quality at the Centers for Medicare and Medicaid Services (CMS): “Quality health care means doing the right thing at the right time in the right way to the right person and having the best results possible.” This does not mean that all our patients get well. It does mean that we perform the right diagnostic tests, make the right diagnosis, implement the correct treatment plan and provide the best possible care in a timely fashion.    There were a variety of factors that led to the development of pay for performance. Among these factors were employer and government concern over rising healthcare costs and deficiencies in the United States healthcare system. The U.S. has a $1.7 trillion health-care industry that still largely records patient information with pen and paper.    Reportedly, only 17 percent of U.S. physicians are currently using EMRs. The Computer-based Patient Record Institute (CPRI) stated that if providers continue with their current paper systems, they will lack the tools needed to manage the quality and costs of healthcare, the scientific basis for healthcare will continue to be undermined, and healthcare reform will be impeded.3

Redefining The EMR System

Also keep in mind that the EMR offers an integration of patient information systems that captures and stores demographic, financial and medical information. They are not simply automated forms of paper charts. According to the Health Information Management Systems Society, a system meets the definition of an EMR system when it is:    •    real time (point of care documentation);    •    reliable (no downtime);    •    secure (Internet systems are unlikely to meet this standard at the present time);    •    is the legal medical record in that the system can operate in a paperless fashion;    •    assists with evidence-based care;    •    automates work flow; and    •    collects the data needed for billing and clinical research.4    While these requirements are complex and specific, in the field of wound management, they are also repetitive, relatively uniform from one patient to another, and involve a small number of procedure codes. Perhaps the most important aspect of a wound specific EMR is its effect on quality of care. For nearly two centuries, the quality of care received by a patient has been dependent on the experience of practitioner. Patients may eventually get the care they need (vascular screening, evaluation for osteomyelitis, etc.) but delays to obtaining these studies negatively affect both outcome and revenue.

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