5 crucial tips to master metrics before they become mandates

Quality metrics have a growing influence on physician compensation. From my decade of experience in an independent practice association and medical group quality initiatives, I’ll share my top tips on hitting targets.

 Always do what’s best for the patient. 

Our primary concern must be patients’ welfare, not health plan mandates. We can explain to patients why and how evidence-based guidelines are determined. Then, we can review the patient’s unique benefits and risks for screening, vaccines or treatment and help them choose appropriate goals. For instance, a pregnant woman with diabetes needs a lower hemoglobin A1c than a frail elderly man. 

Lead with passion. 

I once heard a management guru say, “You get the performance you tolerate.” Practitioners get mediocre results if they don’t enter every visit mindful of metrics. We must challenge ourselves, staff and patients to continuously improve. Celebrate good results, and critique bad ones. Use dramatic anecdotes to motivate: a curable cancer found through screening, or a patient’s weight loss success. Use patient fears of a relative’s bad outcome as a teachable moment. I also limit trials of lifestyle change. Lack of progress after three to six months calls for medication. 

Quality is everyone’s responsibility. 

Build quality into workflow. Clinicians can set standards, then empower staff to work to their license limits. Pre-visit planning is particularly helpful for chronic disease. Front-office staff and medical assistants can contact patients, order tests and book appointments per protocols. At the visit, you’ll have lab tests, imaging or records at your fingertips. Then you can discuss results face-to-face, educate patients, adjust treatment and ensure understanding, instead of ordering after-visit labs and relying on a nurse to call patients days or weeks later, with complex results and instructions. 

Harness your EHR.

Measure baseline, boost accuracy, raise the bar. Since most EHRs now have disease registries, it is easy to measure baseline data and set new benchmarks. However, the results are only as accurate as the data. Delete from the registry any patients who moved or changed doctors. Also delete erroneous diagnoses. A bronchodilator prescription doesn’t always indicate asthma, and a diabetes educator session doesn’t always mean overt diabetes. Verify that screening tests were completed.

Form a team, and name a champion. 

Since the early 2000s, family physician Edward Shahady’s Diabetes Master Clinician Program has helped practices improve diabetes care.  Shahady found most physicians’ baseline metrics were well below what the doctors estimated. Fostering staff teamwork, actively involving patients, and introducing small stepwise changes improved his clients’ goal attainment. Consider a pilot project such as group visits. Run a PDSA cycle: Plan a change; Do it for a few months; Study the results; and Act by tweaking the process. Then repeat the cycle. Finally, appoint a dedicated champion to educate staff and patients on goals, track results and remind team and patients of overdue tasks or uncontrolled labs. Follow-up by “quality czars” has greatly contributed to my practice’s success over the years. 

Embrace changes now so you’re ready when metrics dominate your future paycheck.