Have you heard the Joint Commission’s newest slogan? “Are you down with OPPE? If you’re not, you should be.” I am not sure which is worse: writing a reference to a lame and politically incorrect (if not outright offensive) 1991 hit song, or worrying that you have become so old that no one will get your dated reference.
OPPE–which stands for Ongoing Professional Practice Evaluation–is the Joint Commission’s latest salvo aimed at improving health care: “The intent of the standard is that organizations are looking at data on performance for all practitioners with privileges on an ongoing basis rather than at the two year reappointment process, to allow them to take steps to improve performance on a more timely basis.”
As anyone who works in a hospital knows, when the Joint Commission sneezes, we all get a cold. So I can assure you that your medical staff leadership is busy determining how to comply with this new standard that went into effect January 1. And with most things Joint Commission-related, there are plenty of private vendors stepping in to give you the tools to comply.
But I will argue that the Joint Commission’s goal, which is real-time monitoring of physician performance, is far from ready for prime time. It goes without saying that grading physicians is an exceedingly difficult task, even with this helpful hint, also found on the Joint Commission’s Web site: “While some types of data apply to all practitioner, since performance is different for different practitioner, e.g., cardiologist vs orthopedists, vs obstetricians, there may be need to be specific data.” (Yes, the original contains that garbled syntax and grammar.) If this is the type of rudimentary explanation given for judging physician competence, it is clear that much work has yet to be done.
With the proliferation of EHRs, however, reporting accurate metrics may become substantially easier. My hospital is just now converting to a fully integrated EHR, and what I have been told to expect is truly remarkable. The system has the ability to pull out any performance metric imaginable based on the ordering or performing physician. Data on who spends what–probably the biggest future quality marker–to treat any condition will be at the hospital’s fingertips. And while I have generally been skeptical about grading physician practice, this type of tool may well be different than past efforts.
But what of the low-volume hospital physicians; read: traditional internists and many family practice doctors? Again, from the Joint Commission: “It would not be acceptable to find at the two year reappointment that someone has not performed a privilege for two years.” Will hospitals be forced by this OPPE mandate to pull the plug on doctors with poor metrics and/or low volume?
Many medical staffs are presently dealing with this issue. Our profession is built on the premise that to treat patients well, you need to treat patients frequently. Yet hospitals are justifiably wary of cutting ties with physicians who rarely care for hospitalized patients but still direct much business to said institution. This growing disconnect between a hospital and community primary care doctors should cause concern, especially if the hospital relies on those referral patterns.
Furthermore, the Joint Commission currently asks hospitals if they have hospitalists or plan to start a hospitalist program. It’s not hard to imagine that question becoming, “Do you have board certified hospitalists, or do you plan to mandate their use in the near future?” Adding board certification (or focused recognition) to the mix may well prove to be the final proverbial nail in the coffin for doctors who wish to maintain hospital privileges, despite the fact they practice inpatient medicine infrequently.
Given that this is a hospitalist-centric blog, I guess the question to be addressed is whether being down with OPPE is “good” for hospitalists. My answer: probably. If we hospitalists are worth our salt, a call for real-time, detailed reporting may make our ability to practice efficient and efficacious medicine much more evident.
However, given the shortage of hospitalists, one can only hope that OPPE does not have the effect of causing qualified, low-volume physicians to flee. That definitely would not be good for you, me or our patients.