P4P: For now, focus on three primary elements

Many physicians are concerned and confused about all the discussion on pay for performance, and urologists are no exception. There are still many unknowns and expectations vary, but one thing is sure: Government and other third-party payers are looking at ways to tie practice performance to what they pay for health care services as a means to control the continuing rise in health care costs.

Most of the pilot programs under way are designed to measure processes and identify how often physicians provide appropriate treatments or tests. The goal is to address quality and improve outcomes.

Examine your practice

Urologists need to take a critical look at what goes on within their own practices. For solo practices, this is self-analysis of the variables and outcomes in care and service you provide. For group practices, it means looking at the variables and comparing them to those of other physicians in the group to identify where standardization can improve outcomes.

Patient satisfaction is a good starting point. Within that realm, think about the patient experience and the variables that exist. Access is a good measurement of service that can affect both patient satisfaction and clinical outcomes. The longer a patient waits to get in, the greater the likelihood that his condition may worsen. When is the next available appointment? Is it realistic and is it consistent among the providers? For example, does a patient wait 3 weeks to get into Dr. A, when Dr. C can see the patient within 5 days?

Do you return phone calls promptly and have you set a standard for returning calls? Some urology practices have identified specific problems that should be considered emergent and that require an immediate response, while other clinical calls can wait. If other calls can wait, what is considered a reasonable wait time and how is this communicated to the patient? Is a mechanism in place to spot check staff and physician compliance in returning phone calls?

Be willing not only to examine your practice, but to address and fix problems that have been identified. One of the primary factors in implementing outcome measures is physician agreement on how you will measure quality. The physicians in the group must know, understand, and agree on what to measure.

Begin by selecting an indicator that is clinically significant for which the data are not too difficult to obtain. In urology, an example might be the consistency of ordering PSA tests, ie, how often they are conducted and at what age testing is begun. Do the physicians agree on a standard, do they apply the standard consistently, and is your method of monitoring compliance working?

Electronic records

Electronic medical record systems are costly to purchase and integrate into the practice. This is likely the reason that less than 15% of practices have implemented EMR systems. However, it is expected that future programs will develop with financial incentives for practices that have implemented them.

It's time for urologists to begin exploring EMR options and to set a deadline for implementation. The EMR advantage is not just a component of getting ready for P4P, but such technology will also increase overall efficiency and performance.

Sure it's costly, but most practices recoup the costs within 18 months as a result of reductions in staffing and time savings. Physicians report being able to see more patients with better documentation after implementing an EMR system. And physicians and their clinical staffs find they work in "real time," giving them a better shot at getting out of the office earlier at the end of the day. The on-call urologist can access patient records off site, improving decision-making for the patient after hours, which can directly affect the patient's clinical outcome.