Understanding and Addressing Physicians' Barriers to Achieving Better ACO Quality Metrics
[Editor's note: the following post was written by Dan Malloy PhD, executive vice president, Quantia, Inc.]
ACOs have long understood that patient engagement is a critical element to keeping individuals healthy and the chronically ill stable. Now ACOs are beginning to appreciate the importance of physician engagement and alignment around the cost and quality measures that have emerged as the performance threshold for their organizational health. After all, the criteria driving these metrics often lie in the hands of the physicians associated with the organizations.
However, many ACOs struggle to know for sure that their physicians are aligned in ways that will achieve such metrics. When they're not, it's crucial to understand why. By offering physicians access to web-based, expert-led content on topics that drive these metrics, ACOs and other health systems are helping avoid potential financial penalties associated with these measures, not to mention improve patients' quality of life.
ACOs that fail to reach the quality metric in the area of depression screening may face reduced reimbursement. Yet a recent poll of over 3,500 physicians who participated in an expert-led QuantiaMD content segment on depression screening performance measures found that the majority (61%) only screen patients who present with symptoms. Just 25% say they screen every patient, and 7% say they don't screen any patients at all.
That healthy percentage of physicians who are only screening patients with symptoms may be putting their patients - and their quality metrics - at risk. As one physician remarked, "Since I've started screening every new patient, I've been astounded at the number of ‘good actors' there are in this world with very high numbers on their PHQ but who I would never have dreamed are depressed by their affect. It's been a very gratifying activity."
As part of this segment, these physicians offered their own reasons for the inconsistency, and opportunities for systems to address these barriers.
Reasons cited for inconsistent depression screening include:
- Lack of time (63%)
- Lack of access to mental health services (14%)
- Uncertainty on how to screen (10%)
Opportunities physicians cited to help increase depression screening include:
- More time with patients (57%)
- Better access to mental health services and better screening tools (40%)
- Staff-assisted onsite care support (27%)
- More education on depression (20%)
While physicians may always feel strapped for time, their call for increased education and exposure to available screening tools is something that can be addressed through web-based content, including expert advice on how to best manage these screenings. Concise, interactive presentations that are convenient for physicians-along with the ability to ask questions directly of these experts-enable providers to address the reported obstacles and help them to better leverage the resources that are available to help achieve these metrics.
Colorectal cancer screening
Another key ACO quality metric for which physicians have significant potential impact is colorectal cancer screening rates. Thousands of physicians engaged in an expert-led interactive presentation on the topic on QuantiaMD to brush up on best practices for increasing compliance rates.
Based on a follow-up survey of nearly 300 physicians who interacted with this segment, they appear to have gained a deeper understanding of their influence on increasing screening rates in their practices, and feel greater confidence in their ability to improve screening rates after interacting with the expert led content. For example:
- 75% of physician respondents say the content influenced how they manage colorectal cancer screening in their practice
- 68% feel they can increase colorectal cancer screening compliance rates in their practice after interacting with this presentation
- The number of physicians who say they've initiated a patient activation system since interacting with this content increased by 65%, and the number of those who have since designed a delivery system within their practice to enhance screenings increased by 36%
While many physicians acknowledge that a lack of patient activation is one of the toughest obstacles to overcome, some physicians suggest that we all have a role in helping reverse the major image problem that the preparation for this test has.
As one physician remarked, "The procedure is not always the hesitancy...word is out there that the prep is vile. That said, there are MUCH better preps now (bisacodyl + miralax as one example), which makes it way more tolerable. One awful prep, folks tell 10 people, and then 10 do not go. Easy prep, IV sedation, easy procedure...we need to get the word out there."
The good news is that based on this survey population, at least, the majority of physicians are leading by example-less than 10% of those doctors who are eligible for colorectal cancer screenings themselves admit non-compliance. The reasons they cite for avoiding the test are the same ones their patients have - fear, laziness, other medical problems taking a higher priority, and even the self-described "lousy excuse" of not wanting to give up two days in the office to get the procedure. Recognizing these universal barriers to optimal preventive health can help physicians approach their patient conversations with greater empathy.
The consequences of inconsistent screenings-in terms of undiagnosed medical conditions and reduced reimbursement-are obvious. Gaining a window into physician's attitudes and behaviors around these metrics helps identify and address these issues.
Do you have the insights and physician buy-in needed to address these and other quality and patient care outcomes? The nation is watching.