3 responses to “Facing a College Physician Practice Enhancement Program Assessment? What you need to know in 2019?”

  1. I see no virtue in the QI as opposed to QA approach. None of us would be here if we didn’t start out as caring about excellence. We have a degree that’s considered a doctorate because we’ve achieved a level of professional competence as well as the ability to understand how to maintain it. Those who cut corners to get rich or are losing their abilities need to be dealt with, not simply encouraged along with everyone else to improve a few points so the median goes up.

    I see no virtue in having individuals trying to increase the median documentation performance by each taking their performance up ten percentile points in hopes everyone will improve the same amount and the median will increase by ten. Why should the adequate and stellar ones increase? Will the need to improve in this one particular way ever stop? How can it if we refuse to define adequate?

    As a doctor I want those ‘poor performers’ who rush through and don’t document for financial reasons to have a disincentive to behave that way so I don’t have to hear any claims that there’s no problem with FP remuneration, or to have a WIC owner not want to give me shifts because I’m not a similar poor performer. Likewise as a patient, I don’t need to know that most docs including poor performers are encouraged to be just a bit better so as to raise the median performance. I want to know that poor performers are being dealt with so I am not their unknowing victim. Sometimes it is decline in ability and simple encouragement will not get them to adequate, though requirements to address the cause may. But if it’s lack of concern than that can only be dealt with by threats.

    Also I hope you are not correct and that population health is the next thing they will use to define quality. We are medical experts, not public health experts, and the practice of medicine is an art in dealing with individuals. One thing I’ll never do is exaggerate the benefits of a test or treatment to my patients in order to meet my goals. Nor as a patient do I want to have a College or a government administrator dictate to my doctor what the goals are. It should be helping me meet mine.

  2. Although this would seem to apply to family practice I think a lot applies to specialist physicians. Sharing EMR data with your colleagues can be invaluable as we share the care of so many patients. It can be very difficult to achieve as many physicians prefer to do their own thing.

  3. Thank you for your honest and heartfelt comments!

    In reflecting on what you are communicating, I am interpreting that you feel that physicians should be self-regulating and as professionals, oversee directed self-learning and strive for our own quality improvement and control. I agree wholeheartedly with your statements.

    What you desire and what the intent of the BC College of Physicians and Surgeon’s Physician Peer Enhancement program is, are one in the same. The quality improvement process is about reminding all doctors of your pursuit of self-directed learning and professionalism as not all physicians have dedicated the same amount of time and effort you have invested to improve your clinical care and your practice.

    In my opinion, it is certainly not a college assessor or BC government official dictating how care should be delivered. It is simply a systematic process of experienced peer medical assessors in the same specialty area, along with a second opinion of medical advisors with clinical experience who provide a holistic approach to provide recommendations to improve practice whilst ensuring that safe patient care is the priority.

    This Changed My practice is a vehicle to share ideas and comments. I hope I have conveyed in my article, I certainly am not claiming, I’ve figured it out. I’ve stated I still a lot to learn. I have offered to share with the medical community some observations and thoughts that might help others. I realize my suggestions may not be for everyone, and many physicians may have different interpretations.

    Although not explicitly mentioned in the article, my definition of population health management is using team-based care and the power of the electronic medical record to help improve individualization of care. I am excited that one day, we can use EMR queries and tools to identify care gaps that we as physicians and human being may have missed. It is certainly not about exaggerating tests or benefits but about having individual conversations with our patients, so we can do what we do best, which is be medical experts and provide advice based on our longitudinal and continuous knowledge of and relationships with patients.

    As to your points about what you may have observed or assumed about your medical colleagues in the community, the “poor performers’ who rush through and don’t document for financial reasons” and your concerns for patients, “…Likewise as a patient…I want to know that poor performers are being dealt with so I am not their unknowing victim.”

    First, there is a process to help physicians who are struggling with balancing the practice management issues, documentation requirements and clinical demands. This process allows the PPEP program to identify and offer recommendations with a series of escalating interventions to ensure safe patient care, if required and appropriate.

    Second, the physicians who you mention rush and don’t document for financial reasons have a different authority to contend with, the MSP audit system which is beyond the scope of my article, but another system that may deal with your concerns.

    Once again, thanks for your comments.

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