Hospitals and doctors have used peer review for almost as long as hospitals have existed. In 1986, Congress exempted hospitals and doctors from antitrust laws, making us the only industry where it is legal for competitors to not only review one another’s activity, but also for competitors to work together to limit - or even remove - the privileges of a competitor if they fail to provide quality care.
As important as peer review is, however, it is far from perfect.
As typically performed, it is anecdotal (meaning it is performed on a case-by-case basis), ad hoc (meaning that for the most part, cases are identified semi-randomly instead of systematically), reviewer dependent (what one reviewer finds unacceptable, another reviewer may see as standard of care), and very difficult to link to true quality improvement efforts (it is based on the shaky premise that quality is improved by “fixing” bad doctors).
My favorite analogy is that of an apple orchard, where apples are packed into boxes after being inspected for quality. While a very good inspector (analogous to a peer reviewer) can spot the majority of bad apples, he or she will miss some. More importantly, even if all of the bad apples are removed, that’s still no guarantee the rest are great, or even good. They could still be tasteless, too sour, too soft, not ripe, etc. Quality improvement in an apple orchard takes place away from the packing floor, where experts look at the varieties of apples being grown, their taste, whether trees have gotten enough water and fertilizer, etc.
BayCare is moving away from the “bad apple” approach of quality review to a more “big picture” approach to physician quality review. Crimson is a database program that takes our own BayCare data, puts it through various algorithms, and gives it back to us in an intuitive, interactive, easily interpretable format that we can use to look for trends, problem areas, and opportunities to improve our overall care.
A few of the highlights of this program include:
- Specialty-specific data. Cardiologists can look at results from the cath lab, gastroenterologists can look at outcomes from endoscopies, and surgeons can look at returns to the OR. In other words, the data we - and you - are looking at applies specifically to what you do.
- Attribution of cases. Not only can you choose to look at cases for which you were the attending, or cases for which you were the operating physician, or cases for which you were a consultant, but you can also go to the list of cases attributed to you and remove those that don’t make sense, thus ensuring the numbers are truly meaningful.
- Physicians can be compared to other specialists in their own hospital, those at other hospitals within BayCare, those at other hospitals in Florida, those at teaching hospitals, those at high-performing hospitals across the nation, etc.
- You can look at your own data whenever you choose. This is a web-based program with your own login credentials that is available any time you choose to look at it. The data you’re looking at will be a month or two old at most.
- Department and section chairs can pull up a spreadsheet of all of the doctors in their department or section, and see at a glance which physicians are struggling in which metrics.
- The metrics – those physician-based outcomes we’re looking at – can be changed any time. We have a catalogue of more than 200 different metrics from which to choose.
In summary, this is a program designed not to find the “bad apples,” but rather to see where there are opportunities for improving care before serious problems develop. The goal is to protect patients, make physicians successful, and ultimately achieve our mission of providing excellent care to our communities. You will be receiving your Crimson login credentials soon. We encourage you to use this valuable program often to see how your care compares to other doctors like you here at BayCare or across the nation.