Urologists Urged to Shape Health Policy—With Eye on Quality

Tony Berberabe, MPH
Published Online: Monday, May 5, 2014
Dr. David Hoyt

David Hoyt, MD

Helping to shape American models for medical care, reimbursement, and quality measurement will be key to the success of specialties like urology, and the renovation of the healthcare system taking place under the Affordable Care Act (ACA) leaves plenty of room for physicians to exert that influence, a keynote speaker said during the Urology Joint Advocacy Conference (JAC).

“Reform really needs realistic input,” said the speaker, David Hoyt, MD, executive director of the American College of Surgeons (ACS). “It needs to be framed by what works. We are the ones that provide Congress that concept of what really works. We have got to participate in the regulatory phase; it is our mid-ship opportunity, and ultimately our patients depend upon it.”

To demonstrate how physician groups can help build an effective and fair system, Hoyt offered lessons from the organization’s recent efforts to study a variety of healthcare strategies, as well as some examples of the ACS’s recent legislative wins.

Hoyt said that the rollout of the ACA has directed the country and its medical community into a quest to define the net social value of health care, evaluating the sacrifices versus the gains of different methodologies. He described the ACA as “the good, the bad, and the ugly.”

Important changes, Hoyt said, began with the publication of the National Quality Strategy in 2011. One of its first manifestations was the reduction of payments to medical facilities for the treatment of hospital-acquired infections. Soon to follow were more cost-sharing models: the launch of accountable care organizations, reduced payments tied to hospital readmissions, and value-based purchasing.

It is hoped that these models will lead to “an improvement in the experience of care, the improvement in health populations, and reduction in per-capita cost,” Hoyt said. Along the way, he said, implementation of such changes will offer physicians and their professional organizations chances to help shape quality measures that they will ultimately be enthusiastic about following. He said he was heartened regarding the possibility of working with government to make that happen.

“I really believe, based on my own interaction with Congressional offices in the last 4 years, that most people are trying to do the right thing. And that is an opportunity,” he said.

Defining and measuring quality might conceptually seem straightforward, but “clearly the devil is in the details,” Hoyt continued. For instance, he said, the programs promoted by The Product Quality Research Institute—a consortium of government, academia, and industry working to generate and share information that advances drug product quality and development—sound good, but upon closer inspection, “it’s very difficult to see the actual incentivized quality, based on performance measurement, particularly if physicians do not buy the relevance of the performance measurement.”

Through its Hospital Standards Committee and other databases and programs, the ACS has crafted its own vision of quality medical care: four principles it can discuss with payers and Congress as it works to influence policy, Hoyt said. Organization members have traveled the country to discuss those principles and collect feedback as part of the ACS’s Inspiring Quality initiative.

The first of the four principles, Hoyt said, is to “set standards [for specialties such as cancer care] that are backed by research and individualized to a patient.” The second principle is to build upon infrastructure—whether in outpatient or inpatient settings— through tasks such as defining the staffing levels and equipment needed to achieve specific outcomes. The third principle is to commit to using “qualified data to measure performance against standards.” And the fourth principle is for standards to undergo a “peer-reviewed external verification process, because that is what reassures the public.”

Hoyt emphasized the need to consider financial data, collaborate across specialties and institutions, and create a culture of improvement within each institution and practice.

“We just recently completed a summary of what we learned from this quality tour, and what we really learned is that quality improvement is the future of medicine,” he said. “This is a very, very important message to take to Congress, to show that quality does lead to reduction in complications, and when you add complications being reduced to increase the value, you can actually have cost savings associated with it.”

As an example, Hoyt noted that the application of such principles within hospitals over the last 5 years has led to the reduction of bloodstream-related infections in that setting by 45%.

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