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look worse when they have a lot of noncompliant patients but the quality adjustment is only a small proportion of their payment, it’s not going to really drive behavior to an appreciable degree.
Well, my argument is, if it’s not going to drive behavior then why are you using it? It doesn’t mean we shouldn’t put anything at risk; there are group practices that are experimenting with this and trying to learn from it. But we need to recognize that there are real potential unintended consequences from linking reimbursement to performance on inadequately risk- adjusted measures.
COLLINS: What suggestions do you have for interventional radiologists in particular who are interested in demonstrating
and improving the quality of care that they can provide to patients, payers and hospitals? BARNARD: I think that interventional radiologists would want to be thinking about measures that are truly within individual practitioners’ control and that could be applied without unintended consequences. What things would incentivize the health care team to work together to deliver the best outcome to the patient?
One of the topics with particular relevance to interventional radiology that I’m most interested in is appropriateness: how do we make sure that we’re doing the right procedure for the right patient at the right time?
Another metric that has been used in the past is tracking the rate of
conversion of a minimally invasive to an open procedure. This speaks a little bit to the dilemma of whether we followed the right thought process before we brought this patient in for a procedure.
In addition, I would encourage IRs to move toward measures that look at long-term patient-reported outcomes. This entails asking the patient, “Did you ultimately get better in the ways that were important to you?” That is the longer term Holy Grail of quality: are we collaborating well with our patients to target the outcomes they want, and then delivering those outcomes reliably and without unanticipated complications?
Overall, this is an extraordinarily exciting time to be working in health care quality.
30 IR QUARTERLY | WINTER 2016
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