Originally Posted by
Hmac
We're seeing that in Minnesota now. There's a bill before the legislature that would do away with collaborative agreements and allow full prescriptive authority to NP and CRNAs. Frankly, I don't have a problem with that. At the facilities where I practice, it will mean that they will move from the Allied Health Professions staff to the Medical Staff and will be held to the same oversight and QA process as physicians - quality of care will be maintained. That assumes, of course, that the hospital or any of the practice groups would hire an "Advanced Practice" nurse under those circumstances. That's unlikely at least for the time being. Most likely, if the bill passes, the terms of employment will still require collaboration and oversight and will continue to do so as long as we don't become desperate for mid-levels. Which could happen someday sooner or later. As to CRNAs, Minnesota is an "opt out" state. Physician supervision isn't required by law, but since the CRNAs work for the hospital, they are most definitely subject to oversight by the Chief of Anesthesia.
We've been using Press Ganey for about 6 years for the facility as a whole and for individual physicians. Frankly, in my administrative role, I find it to be pretty interesting and useful for the facility. We do occasionally see opportunities for improvement in patient management and I've used it on a number of occasions to bolster my arguments for facility and training upgrades. I can honestly say that I have yet to see any physician overtly altering their practice in a way that is detrimental to patient care based on their Press Ganey scores.
Anyway, Press Ganey is only one of a whole host of such quality measures that I deal with regularly. We have SCIP, NSQIP, MBSAQIP, and a few other benchmarking QIP's and at least a dozen people whose sole job is data entry and management. And we have an ongoing in-house "report card" system that tracks a number of performance metrics for every physician on staff. I don't know how much it improves patient care, but it sure does cost our patients a lot of money.
These days, physician performance is tracked every which way. IMHO, that's a good thing in large part, at least in facilities where it's utilized constructively. I am skeptical, however, that the Federal government will be capable of doing so as the process continues to mature.
I have no doubt that patient satisfaction surveys provide some useful data. The question remains whether the unintended consequences of coupling physician compensation to this metric outweigh the benefits. That Forbes article makes a strong case that the downside is significant.
I can tell you that tying compensation and satisfaction has been an unmitigated disaster when it comes to emergency department resource use (antibiotics, controlled substances, testing, and admissions). Think about it - almost 40% of ED care is EMTALA driven care to the uninsured (Medicaid + Self-pay). These people also get surveys even though they have absolutely zero financial stake in their care or incentive to conserve resources. None of them will ever come close to paying a co-pay, much less the entire bill. Yet, we incentivize physicians to meet their expectations which are often unreasonable. Personally, I consider lack of payment on a bill to be the equivalent of theft. Giving these people a satisfaction survey is akin to asking a shoplifter at Walmart how they enjoyed their stealing experience after they made off with a TV.
Last edited by Sensei; 03-13-13 at 16:33.
I like my rifles like my women - short, light, fast, brown, and suppressed.
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