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Trend Watch: Performance Standards for Doctors and Healthcare Services


New York, Jan 30, 2002

Two recently announced independent initiatives to set performance standards for physicians--as featured on the front page of The Wall Street Journal (WSJ)--and healthcare providers demonstrate a new awareness of the need in the healthcare arena to raise the quality of its services and provide improved care for patients.

Performance Standards for Doctors

As reported earlier this month by WSJ staff reporter, Rhonda L. Rundle, six rival California insurance companies plan to set common standards for physicians in an effort to "pay bonuses to doctor groups that earn high marks on a common set of quality measures." Blue Shield of California, Well-Point Health Networks Inc.'s Blue Cross of California subsidiary, Health Net, Inc., PacifiCare Health Systems, Cigna Corp. and many of the state's largest health plans are working with a consortia group, the Integrated Healthcare Association, on this initiative. These organizations plan to develop a set of performance standards that could include the following criteria:

  • Preventative and diagnostic measures:
    • Childhood immunizations
    • Breast cancer screening
    • Cervical cancer screening
  • Chronic care measures:
    • Appropriate use of inhalers for asthmatics
    • Effective management of blood sugar levels for diabetics
    • Proper cholesterol levels for coronary artery disease patients
  • Combined patient satisfaction score

Although Rundle said the coalition is "fragile," the significance of six competing insurers--covering approximately one third of the state's insured population--working together cannot be exaggerated. While some individual insurers pay quality-performance bonuses to doctors, this initiative marks the first time that competitors have agreed to develop and use the same performance measures. "This is a huge deal," said Beau Carter, executive director of the Integrated Healthcare Association. "Imagine the difficulty of getting six plans who like to compete and differentiate themselves to agree to raise quality together." Thus far, Rundle reports, "the companies have agreed to tie quality-performance bonuses to the same [criteria], but will make separate decisions about the size of financial rewards." Furthermore, Rundle says that Integrated Healthcare would like to see the plans allocate bonuses of between 5% and 10% above contractual payments, but concedes that in the beginning smaller payments are likely.

Although the increased focus in evaluating and rewarding good doctor performance is a good thing, Rundle interviewed a spokesman from the California Medical Association (CMA), an advocacy organization that represents more than 34,000 California physicians, who indicated that the association is worried about the lack of "broad representation of consumers and physicians" in the initiative. Time will tell if the doctor's concerns are considered by the project's founders.

ANSI's president and chief executive officer, Dr. Mark Hurwitz, CAE, commented on the value of the establishing performance standards for physicians, "The Institute will monitor the development of the consortia initiative and would offer its assistance should these organizations wish to use the formal process to achieve consensus through a broad-based coalition of stakeholders. The voluntary standards process administered by ANSI would help to minimize the CMA's concerns about participation because our process is fair and open. American National Standards serve all interests well because government, consumers and industry work together to create them."

Disease-Specific Care Certification Program

But doctors and service providers are not the only ones affected by the new attention given to healthcare quality. In a recent press release, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) reported "the evolving disease-specific care delivery models and the need for objective evaluation processes…are products of the growing attention being devoted to patients with chronic illnesses by providers, purchasers and public policy-makers."

Scheduled to launch on February 14, 2002, JCAHO has developed a Disease-Specific Care Certification Program to evaluate providers of comprehensive services for patients with chronic illnesses. The evaluation and resulting certification decision will be based on three criteria:

  • An assessment of compliance with consensus national standards
  • The demonstrated effective use of established clinical guidelines to manage and optimize care
  • The measurement and improvement of health outcomes

Currently, there are no standards in place to measure disease-specific care services. At press time, JCAHO and its coalition of leading healthcare organizations are finalizing a set of standards specifically for their certification program and will publish the draft standards to the organization's website in advance of the program's launch. Included in JCAHO's coalition are the National Chronic Care Consortium, the Disease Management Association of America and the Disease Management Purchasing Consortium.

Linda Golodner, member of JCAHO's Certification Advisory Committee and chairman of ANSI's Consumer Interest Council (CIC), commented on the importance of certifying healthcare services, "It is always important for consumers/patients to have additional tools to evaluate whether they receive good healthcare services or not. I think it necessary that they have a say in what those standards are, however, so that the public would have the confidence in the process."

Dr. Hurwitz agreed, stating "Standards are just good ideas unless products and services conform to them. When viewed together, these initiatives demonstrate a very effective model of the voluntary consensus standardization system. The market identified a need and the affected sectors gathered together to create the necessary standards."

Dr. Roy Swift, director of ANSI's personnel certification program, added, "Conformity assessment is like the third-leg of a three-legged standardization stool: (1) a need is identified, (2) standards are developed, and (3) an assessment of conformance to the standard is conducted. The JCAHO initiative, which deals specifically with the certification of healthcare organizations, is one of a vast number of growing programs that certify both organizational management systems and the qualifications of individual personnel."

Certification programs exist to qualify individual expertise. But who evaluates the certifying organization? The Institute is currently developing a Global Accreditation Program for Personnel Certification Bodies, which will facilitate mutual recognition of personnel certification programs such as those offered by JCAHO by providing an internationally recognized framework and evaluation system that operates under a new draft International Standard (ISO/IEC 17024).

JCAHO's mission is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations. It evaluates and accredits nearly 18,000 health care organizations and programs in the United States. An independent, not-for-profit organization, JCAHO is the nation's predominant standards-setting and accrediting body in health care.

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