Talk about physician effectiveness and "outcomes" seems to be everywhere these days. From new payment models within the ACA focusing on said "outcomes" to the new clinical effectiveness institute, it seems that quality measurement is here to stay. Nevertheless, the actual measurement of these variables, much less the definition of the variables themselves (are readmissions and CLABSIs really the best metrics?), is difficult and dense. To top things off, variance in "outcomes" attributed to medical care is only about 10%, with the majorty of gains in quality based in sociodemographic and patient based areas. With so much of the burden of "outcome" based on the patient, but reimbursement for the "outcome" falling on the physician, what are we to do?
Well, from the physician and innovation side of things, we could start by tackling part of the problem up front, by providing meaningful reputaional ranking of physicians. As a physician myself, I have an internal algorithm for ranking my peers, just as any member of a skilled workforce has opinions on who is "recommended" for various tasks; however, not everyone in the United States or world for that matter has a friend or family member who can recommend physicians using first hand knowledge of their credentials, experience, outcomes, and general demenaor. Wouldn't it be great if we could somehow design an effecient algorithm to rank physicians based on a variety of differentially-weighted variables.
Well at my new employer, Grand Rounds Health, this is one of the many things that we are designing and providing for our patients. Using a variety of inputs, including but not limited to claims data, education/training history, experience, publication/research, among other things, we are able to create a clear ranking of physicians that we feel are the ideal doctor for the disease or issue our patients are experiencing. And the best thing is, they can be filtered by location and coverage! All the sudden, a network/clearinghouse effect happens, where patients get to see better doctors, and doctors want to get/be better to join the network. Meaningful data powering meaningful decisions. Everyone wins!