Doctors must drive quality as providers move from volume to value, expert says

LAS VEGAS -- "If I walk down to the doctors lounge and I punch a physician in the face, he is engaged. If I find a way to work with him he can be aligned. Which one are you doing to your physicians in your hospitals?"

That's the question Shawn Griffin, MD, chief quality and informatics officer for Houston-based Memorial Hermann Physician Network, posed Monday at the Volume to Value-based gathering at HIMSS16, illustrating what he says should be the key driver in any system's move from volume to value-based payment. Griffin, who also serves as the Centers for Medicare and Medicaid Services liaison and quality contact for the Memorial Hermann Accountable Care Organization, directs the quality measurement and data collection programs for the most financially successful Medicare Shared Savings Accountable Care Organization in the country.

According to Griffin, Memorial Hermann shows $4.5 billion in annual revenue and $438 million in annual community benefit, having adopted the philosophy that no matter what, the key is highly reliable hospitals. With that in mind, in 2000, they formed a Clinical Programs committee, giving their physicians a leading voice in driving quality.

"If you don't involve the physicians in the quality agenda and the process, then what you're doing is making decisions and then asking for physician buy-in. Doctors don't want to buy in, they want to contribute and be involved from the beginning. Take your doctors your problems earlier. You'll have champions from the beginning," said Griffin.

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The committee is an across-the-system endeavor, said Griffin. Two doctors from every specialty sit down every month and make decisions about how to better take care of patients. The members are looked at regularly, as are the decisions they make to see what is yielding results and what isn't. Practice recommendations are made and adjusted depending on clinical outcomes and results. Other medical staff also weigh in on this committee.

"You have to practice evidence-based medicine… In 2014 we had 510 different evidence-based practice recommendations by our physicians where our physicians got together looked at the evidence and said this is the way we should do it. They passed it and it went through," said Griffin.

They attacked the issue of foreign bodies left in patients in this way, continually adjusting rules made as results got better. Ultimately, the incidents stopped, said Griffin. And this approach does more than just bolster quality.

"Evidence-based medicine is not clinical evidence-based medicine, it could mean financial evidence-based medicine. What is cost-effective is just as valuable as what is clinically efficacious." said Griffin.

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In 2005, they began a clinical quality integration initiative whereby doctors volunteered to have their quality metrics looked at and shared among their peers for the purpose of improvement.

"That core of physicians were the ones who made up their Medicare ACO and it's the reason why we have 10 percent year-over-year savings against our benchmark."

Since evaluating doctors and their quality data is an inevitable part of quality-based models and value-based payment, Griffin said to stay constructive.

"If you are shaming people with the data you're doing something wrong," said Griffin.

Twitter: @BethJSanborn