We recently conducted an in-depth study at Lumere to gain insight into physicians’ perceptions of clinical variation and the factors influencing their choices of drugs and devices. Based on a survey of 276 physicians, our study results show that it’s necessary to consistently and frequently share cost data and clinical evidence with physicians, regardless of whether they’re affiliated with or directly employed by a hospital. This empowers physicians to support the quality and cost goals inherent in a health system’s value-based care model. Below, we offer three recommendations for health systems looking to do this.
Assess how data is shared with physicians. The reality is that in most health systems, data sharing occurs in irregular intervals and inconsistent formats. Ninety-one percent of respondents to our survey reported that increasing physician access to cost data would have a positive impact on care quality. However, only 40% said that their health systems are working to increase physician access to such data.
While working directly with health systems to reduce clinical variation, Lumere has discovered firsthand that the manner and type of cost and evidence-based data shared with physicians varies dramatically. While some organizations have made great strides in developing robust mechanisms for sharing data, many do little beyond circulating the most basic data from the Centers for Medicare and Medicaid Services’ patient-satisfaction survey (the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS).
There are multiple explanations as to why health system administrators have been slow to share data with physicians. The two most common challenges are difficulty obtaining accurate, clinically meaningful data and lack of knowledge among administrators about communicating data.
When it comes to obtaining accurate, meaningful data, the reality is that many health systems do not know where to start. Between disparate data-collection systems, varied physician needs, and an overwhelming array of available clinical evidence, it can be daunting to try to develop a robust, yet streamlined, approach.
As for the second problem, many administrators have simply not been trained to effectively communicate data. Health system leaders tend to be more comfortable talking about costs, but physicians generally focus on clinical outcomes. As a result, physicians frequently have follow-up questions that administrators interpret as pushback. It is important to understand what physicians need.
Determine the appropriate amount and type of data to share. Using evidence and data can foster respectful debate, provide honest education, and ultimately align teams.
Physicians are driven by their desire to improve patient outcomes and therefore want the total picture. This includes access to published evidence to help choose cost-effective drug and device alternatives without hurting outcomes. Health system administrators need to provide clinicians with access to a wide range of data (not only data about costs). Ensuring that physicians have a strong voice in determining which data to share will help create alignment and trust. A more nuanced value-based approach that accounts for important clinical and patient-centered outcomes (e.g., length of stay, post-operative recovery profile) combined with cost data may be the most effective solution.
While physicians generally report wanting more cost data, not all physicians have the experience and training to appropriately incorporate it into their decision making. Surveyed physicians who have had exposure to a range of cost data, data highlighting clinical variation, and practice guidelines generally found cost data more influential in their selection of drugs and devices, regardless of whether they shared in savings under value-based care models. This was particularly true for more veteran physicians and those with private-practice experience who have had greater exposure to managing cost information.
Health systems can play a key role in helping physicians use cost and quality data to make cost-effective decisions. We recommend that health systems identify a centralized data/analytics department that includes representatives of both quality-improvement teams and technology/informatics to own the process of streamlining, analyzing, and disseminating data.
Compare data based on contemporary evidence-based guidelines. Physicians would like to incorporate reliable data into their decision-making when selecting drugs and devices. In our survey, 54% of respondents reported that it was either “extremely important” or “very important” that hospitals use peer-reviewed literature and clinical evidence to support the selection of medical devices. Further, 56% of respondents said it was “extremely important” or “very important” that physicians be involved in using data to develop clinical protocols, guidelines, and best practices.
Health systems should ensure that data is organized and presented in a way that is clinically meaningful and emphasizes high-quality patient care. Beginning the dialogue with physicians by asking them to reduce costs does not always inspire collaboration. To get physicians more involved, analyze cost drivers within the clinical context.
Finally, health systems should keep data and communication simple by developing, communicating, and mobilizing a small number of critical key performance indicators (KPIs). These indicators should reflect the voices of health care customers, including patients, care providers, and payers. In some instances, these will overlap — for example, length of stay, infection rates, readmissions, and likelihood to recommend the provider in the future. Consistent, relevant benchmarks will keep physicians focused on organizational goals.
Our survey results paint a vivid picture: Health systems openly and transparently engage with both employed and affiliated physicians and foster a culture that appreciates data and analytics. Only then will we see improved clinical, operational, and financial outcomes.
Scott Falk, MD, is director of performance improvement, quality, and safety and associate professor of anesthesiology and critical care at Penn Medicine. He is a physician advisor to Lumere, an organization focused on helping health systems eliminate unwarranted clinical variation and cut unnecessary costs.
John Cherf, MD, is chief of orthopedic surgery at the Advocate Illinois Masonic Medical Center in Chicago, part of the Advocate Health system, and is chief medical officer Lumere, an organization focused on helping health systems eliminate unwarranted clinical variation and cut unnecessary costs.