Nancy Rudner: What makes a good doctor?

How do you pick a physician, nurse practitioner, home health agency, or hospital to care for you or a loved one? You can arm yourself with spreadsheets of information on the quality of a car as you head to the dealerships, but how do you know about the quality of your health care? Word of mouth is a popular method, but that really tells you more about the practitioner’s personality than the quality of care.

Most people know that part of the health care reform law increases coverage for the uninsured. Few people know that a huge part of the law strives to improve quality of care, with significant changes in how health care is delivered. Many provisions increase transparency in health care — more information on the quality of care available to purchasers and consumers. A click on www.healthcare.gov/compare reveals some of the ways health care organizations report their quality. Clinician quality data is not yet on that website, but home health and hospital information are.

All physicians and nurses are licensed by the state to ensure minimum qualifications. Board certification is another indication of the individual practitioner’s quality. The PCMH practice recognition is recognition of the quality of the practice, including how it operates. We also have many skillful practitioners and practices that do not seek the PCMH accreditation but have the same high quality components. Since seeking PCMH recognition takes time and money, some practices focus on the practice and do not seek the external recognition.

One of the basic ideas of improving care is that what gets measured gets improved. Quality measures look at many aspects of care, such as the percent of women in a practice who have had a mammogram, the percent of patients with diabetes who have good control of their blood sugar, and the percent of appropriate medications are prescribed for certain conditions. Proactive practices may use such measures to follow improvements in care.

Two leading quality recognition organizations — the Joint Commission and the National Committee for Quality Assurance — recognize medical practices for meeting specific criteria associated with high quality care. This recognition is called Primary Care Medical Homes by the Joint Commission and Patient-Centered Medical Homes (also PCMH) by NCQA. NCQA also has a recognition program for providers of stroke and cardiac care and another highlighting quality of diabetes care. Over 100 Central Florida practices have earned these recognitions of quality.

Criteria for earning this quality recognition include processes and systems for better patient access and care effectiveness. Practices need to ensure easy access for patients with expanded hours and easy communication, by phone and possibly email. They need robust processes to keep the patient informed and make sure tests have adequate follow up. One of the biggest challenges in medical care is coordination across multiple locations and providers. Tests may be done in one location, consultations in another, and hospital care in another system. PCMHs coordinate care and track care across the dizzying array of settings. PCMHs also have staff that helps patients understand and manage their health. The practice must also look at its data, identify what needs to be improved, implement improvement strategies, and track changes over time. To operate as effectively and efficiently as possible, practices need to utilize the multiple skills of a team and ensure that everyone on the team is working “on the top of license” to the full extent of each person’s education and training.

In some parts of the country, health plans contract only providers that have earned a quality recognition. Some health plans are moving from paying for what gets done (paying for the visit, the tests, etc.) to paying for outcomes (paying for improved diabetes control, fewer hospitalizations, etc.). Paying for value may replace paying for volume but defining value is the sticky part. We will witness significant changes in our health sector in the coming years. But as always, it is best to live as healthy a lifestyle as possible to boost your resistance to health problems and their complications.

Nancy Rudner Lugo is a workplace nurse coach and health care consultant for HealthAction.biz. Send her your questions at [email protected]