Health Innovation Specialists Will Do Measurements on Its Own
Dr. Charles Eckstein
As the phrase “cost and quality” becomes synonymous with healthcare reform, and physicians find themselves talking about benchmarks and metrics, a collection of eight Nashville-area medical practices are working to define those measurements for surgical specialties – and breaking ground in the process.
Founded in October 2011, Health Innovation Specialists is a physician network that will collaborate on clinical initiatives to try to drive down healthcare costs while bumping up care quality. “This is really new territory, and we’re hearing a lot of excitement about it in the payer community and in the hospital community. The models that are out there are really primary-care driven so far,” said Beth Scarvey, a Franklin healthcare consultant who’s working with HIS on its organization. President of Healthcare Development Resources, Scarvey said, “I was not hearing a lot of surgical specialists getting together in an IPA (independent practice association) sort of format, but I think that it makes a lot of sense for surgical specialists to get together and focus on quality initiatives and really start to measure cost and quality. Everyone is concerned about the cost of healthcare, and part of that is quality and part of it is just the question, ‘Is there some cost to squeeze out of the system?’ So the group formed an IPA.”
HIS’s chairman is Charles Eckstein, MD, president of Urology Associates. At the time HIS was established, Eckstein said, “With the changing face of healthcare, it is imperative that patient care remains the priority. The members of Health Innovation Specialists will collaborate to develop clinical benchmarks that measure the quality of the care they provide. Ultimately, patients will benefit from superior service while local providers advance their practices.” In addition to Urology Associates, the other founding members of HIS are:
Anesthesia Medical Group,
Howell Allen Clinic,
Otolaryngology Associates of Tennessee,
Tennessee Orthopaedic Alliance,
Tennessee Women’s Care and
The Surgical Clinic.
The practices are footing the bill for the quality and cost-saving initiative.
Scarvey said the idea for HIS germinated in early 2011, and the objective is to focus on different “episodes” of care, surgical cases that have higher costs associated with them and “areas of the healthcare spend that can be controlled. Part of that is, No. 1, just developing metrics. Nobody has really done this in the surgical specialty area.”
For example, consider knee replacements. What are the costs associated with each surgeon, hospital costs, cost of the implant and post-discharge costs? Are there certain physicians who are just flat-out better at knee replacements than others? Is their number of complications lower? Are their patient turn-around times quicker? If so, then the practice should funnel more knee replacements to those surgeons and ensure other surgeons are utilized to their best potential, too. Scarvey explained, “The physicians are committed to looking at themselves and asking, ‘How are we doing personally in terms of cost and quality, and then how do we impact how we’re doing from a cost and quality perspective?’ ”
Initially, HIS will develop a list of surgical cases and partner with a couple of private payers to obtain a strong data set and develop the metrics. Scarvey said some payers are interested, but it’s too soon to reveal which payers they are. Phase 2, which should begin next year, will be “developing care paths and initiatives to impact cost and quality,” she said, adding that results will be “several years down the road.” She did predict that the initiative should result in some strong research worthy of publication in a medical journal.
Considering that today’s reimbursement environment is still fee for service, Scarvey applauded the HIS members for their forward thinking. “I think it’s admirable to see physicians who are interested in focusing purely on impacting cost and quality,” she said. “I don’t see that very often in what I do.”