case report value share with other physicians patient outcome

Are there Patient Reported Outcomes in value based payments?

1 Patient Reported Outcomes in Value Based Payments Cecily Froemke, PhD Author Note: This presentation was prepared for the 2018 Washington Medical Commission Educational Conference 2 Learning Objectives:

Can Patient Reported Outcome measures help transform health care?

Black N. Patient reported outcome measures could help transform health care. BMJ. 2013;346:f167. [PubMed] [Google Scholar] 9. Rathert C, Huddleston N, Pak Y. Acute care patients discuss the patient role in patient safety. Health Care Manage Rev. 2011;36(2):134–144. [PubMed] [Google Scholar] 10.

Why are Patient‐Reported Outcomes important in veterinary medicine?

As veterinary medicine has become more specialized and more complex, multidisciplinary communication and trust among the care team are paramount in providing value to patients (and clients). Use of patient‐reported outcomes is an essential aspect for improving clinical care, because it enhances the connections among doctors and with patients.

What is guidance for industry patient-related outcome measures?

Guidance for industry patient-related outcome measures: use in medical product development to support labeling claims. Washington: U.S. Department of Health and Human Services Food and Drug Administration; 2009.

How does value-based care affect physicians?

In a value-based system, providers such as hospitals and doctors are paid based on patient outcomes, rather than the current ​“fee-for-service” model. In other words, the provider is rewarded for helping patients become healthier. It's a proactive approach, rather than a reactive one.

Are case reports valuable?

Case reports are valuable resources of unusual information that may lead to new research and advances in clinical practice. Many journals and medical databases recognize the time-honored importance of case reports as a valuable source of new ideas and information in clinical medicine.

Does case reports require patient consent?

As explained above, informed patient consent is mandatory for the publication of your case reports. Ignoring this requirement can result in a rejection for your work and worse, ruin your relationship and reputation with patients.

How do you write a case presentation for a case report?

Case reports should encompass the following five sections: an abstract, an introduction with a literature review, a description of the case report, a discussion that includes a detailed explanation of the literature review, and a brief summary of the case and a conclusion.

What is a case report and what is its importance?

Case reports are defined as the scientific documentation of a single clinical observation and have a time-honored and rich tradition in medicine and scientific publication. Case reports represent a relevant, timely, and important study design in advancing medical scientific knowledge especially of rare diseases.

What is the purpose of case report?

A case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports usually describe an unusual or novel occurrence and as such, remain one of the cornerstones of medical progress and provide many new ideas in medicine.

Do case reports require ethical approval?

Case reports and studies intended for quality improvement are often considered not research and do not need IRB approval. Nevertheless, there should be some processes of clearing those studies with respect to ethical handling of patients and related data.

Do case reports count as publications?

Case reports have now been developed and accepted as a scholarly publication to disseminate knowledge to a wide medical audience.

Does a case report need IRB approval?

Under HIPAA, a case report is an activity to develop information to be shared for medical/educational purposes. Although the use of protected health information to prepare the paper does not require IRB review, the author of a case report must comply with HIPAA.

What does a case report include?

An article that describes and interprets an individual case, often written in the form of a detailed story. Case reports often describe: Unique cases that cannot be explained by known diseases or syndromes. Cases that show an important variation of a disease or condition.

How do I write a medical case study report?

Case: This section provides the details of the case in the following order:Patient description.Case history.Physical examination results.Results of pathological tests and other investigations.Treatment plan.Expected outcome of the treatment plan.Actual outcome.

How do you write a patient medical report?

HOW TO WRITE A MEDICAL REPORTKnow that a common type of medical report is written using SOAP method. ... Assess the patient after observing her problems and symptoms. ... Write the Plan part of the Medical report. ... Note any problems when you write the medical report.More items...

Why is VBVC important?

Society's relationship with animals is changing, likely influencing the medical care that owners desire for their pets and contributing to the increase in veterinary patients for which care includes referral to a specialist. 15As veterinary care becomes more complex and costly, VBVC can be a way to provide high value care to patients and clients, while helping us understand the outcomes and costs involved with care.

Why is infection prevention important in veterinary care?

This figure highlights the importance of patient‐centered infection prevention in increasing the quality of care. In the tibial plateau leveling osteotomy example, the improved asepsis protocol will lead to less infections hence improve antibiotic stewardship. Furthermore, the lower complications (surgical site infections) post‐surgery will lead to faster rehabilitation and recovery, overall leading to improved outcomes (improved quality of life) and decrease costs. This is the basis at enhancing the value provided to our patients and clients through the value‐based veterinary care framework

How is value based care created?

Value is created by improving the outcomes of patients with a particular clinical condition over the full cycle of care, which normally involves multiple specialties and care sites. To be successful, a key aspect of value based care is working as teams (integrated practice units) centered around the patient's clinical condition. As veterinary medicine has become more specialized and more complex, multidisciplinary communication and trust among the care team are paramount in providing value to patients (and clients).

What is value based care?

In value‐based care, the only true measures of quality are the outcomes that matter to patients. When outcomes are measured and reported, it fosters improvement and adoption of best practices, thus further improving outcomes. Understanding outcomes is central in providing value and represents an opportunity for redefining veterinary patient care.

What are the challenges of outcome measurement?

Aside from survival, outcome measurement remains limited.24Two main challenges for outcome measurement are organizational structure and information technology systems. The tendency is to measure only what the care team directly controls in a particular intervention, what can be measured easily, or the intervention and treatment that can be billed. Furthermore, rather than determining outcomes for the full care cycle over which value is determined, outcomes are assessed for department or billing units. In health care, outcome work often is driven by medical specialty experts or consensus panels, and not multidisciplinary groups for medical conditions. Organizational structure could explain why doctors fail to accept responsibility for outcomes, defending this position by citing their lack of control over “outside” players involved with patient care (even if they belong to the same hospital) or patient compliance.20An additional barrier is the cost implied in obtaining longitudinal patient data because of organizational fragmentation. Lack of an electronic medical record system that could effortlessly capture outcome data and compile it remains a challenge for many health care systems.20Many of these hurdles in outcome data measurement can be easily extrapolated to veterinary medical care, and thus we have a great opportunity for learning about and improving the way care is provided to our patients.

Why is patient-reported outcome important?

Use of patient‐reported outcomes is an essential aspect for improving clinical care, because it enhances the connections among doctors and with patients. Designing and implementing owner‐reported outcomes in veterinary clinical practice will lead to an understanding of the effects of treatments on outcomes and quality of life (QOL) of our patients from the owner's perspective, a key way to assess a veterinary patient's QOL.

What is value maximization?

Value is defined as health outcomes achieved that matter to patients relative to the cost of achieving those outcomes. Improving value requires either improving 1 or more outcomes without increasing costs or lowering costs without negatively affecting outcomes, or both.7Important considerations regarding this concept are: value is not synonymous with cost savings; outcomes should be multidimensional and be defined by the context of the patient; cost determinations should include all costs and, as a result, some costs may increase for others to decrease; and, value is best considered on a long‐term basis.13

What is a peer review in PCORI?

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research . It also confirms that the research has followed PCORI’s Methodology Standards. During peer review, experts who were not members of the research team read a draft report of the research. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. Reviewers do not have conflicts of interest with the study.

What were the results?

Three months after the doctor visits, there was no difference in symptoms between patients whose doctors got survey information about patient symptoms and patients whose doctors didn’t get this information. There was no difference between the two groups in how much patients talked about their symptoms during doctors’ visits, how much patients wanted treatment for the symptoms, or how happy patients were with treatment for their symptoms. There was also no difference between the groups in how often doctors made notes about patients’ symptoms in the patients’ medical records or how much care patients got for their symptoms.

What was the research about?

These symptoms can be signs of a health problem. Knowing about symptoms can help doctors find ways to help patients feel better. Using patient-reported outcomes (PRO) surveys is one way for doctors to collect this information. These surveys ask how health problems and their treatments affect patients from the patients’ point of view. Filling out PRO surveys helps patients tell their doctors how they are feeling.

Why is it so difficult to link patient-reported outcomes to particular treatments?

Another major reason is that, generally, clinicians are not able to bill for time spent fielding outcomes surveys or interpreting such data. It's also difficult to link patient-reported outcomes to particular treatments since many factors—including patients' compliance and social factors—influence outcomes.

Why are patient-reported measures important?

In coming years, patient-reported measures are expected to play a more prominent role in assessing performance and determining the comparative effectiveness of different treatments, in part because of a growing emphasis on patient-centered care and value-based payment approaches. For example, by 2015, health care providers participating in accountable care organizations will have to provide evidence that the care they've delivered produced value for the patient—as reported by the patient. The Department of Health and Human Services' Office of the National Coordinator for Health Information Technology also plans to incorporate PROMs into meaningful use standards, which is likely to prompt more widespread use.

Why do patients complete surveys online?

At the center, patients complete the surveys online so that the results are available for their initial clinic visits. The data are collected over time and stratified by illness burden, enabling the center to compare whether a medical or surgical intervention is best for a specific condition. The results are posted on the center's Web site and patients are encouraged to review them as they consider different treatment options.

What is a prom in clinical practice?

Use of PROMS in Clinical Practice. In the U.S., PROMs are in the early stages of development for use in clinical practice, as opposed to research. They have been most widely used to monitor conditions that rely on patients' reports (rather than diagnostic tests), such as depression or certain gastrointestinal disorders.

What is the Office of the National Coordinator for Health Information Technology?

The Department of Health and Human Services' Office of the National Coordinator for Health Information Technology also plans to incorporate PROMs into meaningful use standards, which is likely to prompt more widespread use.

How to promote more widespread use of Proms?

To promote more widespread use, many say, the surveys should also be easy for patients to complete, for example through smartphone apps, Web-based tools, or even in kiosks in drug stores. PROMs data also need to be easy to bring forward at the point of care, says Chris Weiss, co-founder and president of Dynamic Clinical Systems, a vendor of PROMs software and management services. "Electronic health record vendors need to treat PROMs like lab results or anything else that are stored in the record—rather than one-off side issues."

Purpose

This study examined the impact of the Physician Quality Reporting System (PQRS) on the quality and cost of care for Medicare patients. PQRS enables individual physicians and other eligible professionals to voluntarily select the measures to report data on the quality and outcomes of care provided to Medicare beneficiaries.

Methods

The analysis uses a difference-in-differences model to compare changes in outcomes over time (from before implementation of PQRS in 2005 and 2006 to after implementation in 2008 and 2009) for practices that submitted PQRS reports to those that did not.

Results

Participation in PQRS was associated with a significant, desirable (negative) effect for two of three measures of avoidable utilization across the entire sample of beneficiaries.

What is FFS in healthcare?

FFS can be a purely transactional model. A patient comes to a hospital or medical office, service is provided, the patient and/or insurer is billed, and the facility/medical group receives payment. Under the VBC model, physicians and care teams should have a financial incentive for preventing members from becoming patients in the first place. VBC is in line with physicians’ intrinsic motivation to deliver the best care to their patients. In our experience, refocusing work from productivity to value can bring more meaning to physicians’ work and help reduce burnout. However, getting physicians to embrace a new compensation model can be a challenge, as we noted in our report on physician-alignment strategies for health systems. Although no single compensation plan will work for all physician-employment arrangements, it is important that physician income correspond with clearly defined performance measures. Redesigning a physician-compensation model should include the following strategies:

What should be considered when addressing physician compensation in a VBC model?

The type of facility is one factor that should be considered when addressing physician compensation in a VBC model. For example, physicians in a primary-care practice, a surgical practice, and a hospital based practice will all look different. There might also be significant differences among the physicians within the same facility.

Why are physicians involved in the VBC design process?

Physicians who feel they share in the financial risk when caring for a population are more likely to accept new payment models. Involving physicians in the VBC design process—for example, as part of a physician compensation committee—could help encourage buy-in.

What is physician compensation?

Physician compensation is a complex, but critical lever in the VBC model. For example, innovative VBC models can be used to group certain types of physicians when they share patients. A model that aligns incentives for emergency medicine, hospitalists, and primary care physicians, for example, could help reduce new hospital admissions.

What is Dorrie's role in Deloitte?

She is also a founding member of Deloitte’s cross-function / cross-sector Value Based Care leadership team. Prior to joining Deloitte, Dorrie served as the VP of Operations for a 600+ faculty physician practice plan and as the Director of Operations for a physician practice management company. Dorrie has extensive knowledge of the ambulatory landscape and across all specialties spanning strategy, clinical operations, business operations, regulatory compliance, human capital, and technology. As a respected industry expert, Dorrie has spoken on the national and international stage and published multiple journal articles. Topics have included innovation in primary care models, healthcare trends for investors, impact of the volume to value shift, designing high value physician networks, growth strategies, population health, care management innovation, and accountable care. Dorrie’s consulting experience includes leading efforts in M&A integration / day one planning; provider engagement; physician payment model and incentive redesign; primary care strategy, network development, and clinical integration; population health and care management innovation; access enhancement; provider/plan collaboration, partnerships, and integration; workforce planning; patient retention and steerage programs; value based care transformation; and clinical access, efficiency, and throughput.

How to ensure consistency in specialty?

Strive for consistency within—and equity across—specialties: Organizations should try to ensure standardization within specialties while recognizing their different contribution to the value equation. For example, primary care physicians (PCPs) might be seen as having more ability to drive quality, while specialists might be seen as having more of an impact on cost. A specialty-based incentive structure might consider panel size, quality, outcomes, productivity, and retention of patients within the defined network. The model should allow for some personal choice and preference at the individual level.

Why should physicians have tools and support?

Physicians should also have tools and support to help them translate data into areas where they can improve performance. Clinical decision-support systems should help ensure that the right treatment choice is also the easy choice for physicians.

What Was The Research About?

What Were The Results?

Who Was in The Study?

• The research study included 300 adult patients. The patients got care at primary care clinics in Indianapolis, Indiana. The patients had medium to severe sleep problems, pain, anxiety, depression, or low energy. About 70 percent of patients were female. Forty-nine percent of patients were African American, 45 percent were white, and 6 percent were ...

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What Did The Research Team do?

What Were The Limits of The Study?

How Can People Use The Results?