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The Accountability Moment

10 Principles for Moving Beyond OPPE to a Rigorous, Credible Physician PI Framework

Topics: Physician Issues, Performance Improvement

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While the Joint Commission's 2007 mandate of Ongoing Professional Practice Evaluation (OPPE) was a positive step forward on the path to Performance Improvement (PI), industry leaders agree that many hospitals have far to go to fully realize the benefits of health data. This study profiles progressive hospitals that are deploying OPPE programs and highlights key lessons learned.

After reading this study, members will be able to:

  • Support physician PI program by scaling up internal staff resources
  • Incorporate strategic performance analysis best practices into physician PI programs
  • Openly address issues of major physician opposition, such as case attribution and malpractice discoverability
  • Communicate clearly to medical staff the purpose and implications of PI

Executive Summary

Joint Commission’s OPPE mandate spurred hospitals to begin PI program efforts

Many hospital leaders have long believed that greater use of physician-specific analysis would significantly assist hospital quality improvement and efficiency promotion efforts. Yet most hospitals refrained from rolling out such programs due to the major practical and political obstacles involved—until recently. In 2007, The Joint Commission’s Ongoing Professional Practice Evaluation (OPPE) and related requirements created the first real hospital mandate for systematically evaluating the individual competency of every member of the medical staff. This requirement spurred hospitals to construct (at least entry-level) programs to measure individual-level performance across physicians.

OPPE-oriented programs just the beginning of PI

While OPPE-oriented physician measurement programs represent a significant initial step into the territory of physician performance improvement (PI), in the larger picture, hospitals have barely scratched the surface of the work that remains. Far beyond what is needed to “check the box” for Joint Commission today, tectonic shifts in the health care industry will require major ongoing commitment to physician PI. New reimbursement models, intensified cost reduction mandates, and ongoing quality improvement imperatives will all hinge upon successful measurement, analysis, and support for performance improvement of all physicians on the medical staff. Thus the most progressive hospitals and health systems interviewed in the course of this research framed their efforts on physician PI as “just beginning.”

Costly programs, lack of insfrastructure, siloed data present challenges to PI efforts

In striking contrast to any long-term aspirations toward broad and substantive use of physician analytics, the on-the-ground reality at most hospitals is that most are struggling. Performance measurement is still extremely suspect in the eyes of the medical staff. Programs are costly to build, because most hospitals have no existing infrastructure for the required analysis, and physician performance data is siloed and difficult to access and aggregate. Programs are geared more toward compliance with current regulatory requirements (e.g., OPPE) than toward advancing organizations’ own strategic goals in quality of care. As a result, current physician performance metric sets often represent the path of least resistance—disconnected from any larger sense of “what it all means” in the context of the organization’s efforts to raise quality of care.

Access the study to learn more

This study draws upon the experience of progressive hospitals and health systems that are deploying OPPE programs as part of a larger organizational commitment to physician PI. Key lessons learned have been distilled into 10 critical building block principles, illustrated with example models and tactics for building a robust physician PI infrastructure.

Essay: Ready or Not—The Advent of Mandatory Physician PI

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