Latest / Becker’s Healthcare Podcast / Rethinking Quality Metrics in Healthcare with Dr. Maulik Purohit

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Rethinking Quality Metrics in Healthcare with Dr. Maulik Purohit · Becker’s Healthcare Podcast

• 0:00
  Hello, and welcome to the Becker's HealthCare podcast.
• 0:02
  My name is Chanel Vungar. I'm excited to
• 0:04
  speak with regular guest, doctor
• 0:06
  Malik Purahit, chief health information officer at Databox
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  Digital Health Labs, who joins us regularly to
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  share insights into some trends that he's keeping
• 0:15
  an eye on. Today, Today, he joins us
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  to discuss quality metrics. Doctor Perrahed, thank you
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  so much for joining me today. Thanks, Chanel,
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  for having me. It's always a a pleasure
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  to to be on, this podcast. You have
• 0:25
  so many, great speakers and then great thoughts
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  discussed here.
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  Perfect. And for listeners who may not know
• 0:31
  you yet, could you introduce yourself and share
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  a bit about your background?
• 0:35
  Sure. Hey, Chanel. So a couple of things
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  that that's unique about my background.
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  I actually currently serve as head of innovation
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  for PAM Health, which is a a post
• 0:44
  acute hospital system,
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  nationally. So I'm in the health system side.
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  And then I also serve as chief innovation
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  officer for, Dactosex, which is actually a research
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  company, and we provide research services for digital
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  health. And it's a unique perspective because I'm
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  both on
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  the health system side, understanding the,
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  challenges there and opportunities there, as well as
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  on the industry side, working with several companies
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  for solving some of those challenges. And so
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  it's a nice bridge between both aspects of
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  of health care and gives me a very
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  different perspective than having one or the other
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  alone.
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  Thank you so much for that introduction. And
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  now diving into the podcast a bit,
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  can you give us a quick overview of
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  quality metrics?
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  Sure. Absolutely. You know, quality metrics were designed
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  for what it seems like, which is improving
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  quality in a health system. And then the
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  idea was that if we had metrics and
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  people were given certain guidelines and then rules
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  around them, then we could incentivize,
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  better patient care and, as a result, have
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  a healthier population.
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  Makes a lot of sense. Very logical.
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  I think the difficulty happens in the execution
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  of that, though, is what metrics do we
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  decide on,
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  how do we implement them, and and then
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  how,
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  are people reimbursed for some of those quality
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  metrics, meaning health systems usually.
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  And I think it's been it's been interesting
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  perspective seeing if as
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  both on the admission side as I've been
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  chief health information officer. So helping set up
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  the digital infrastructure
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  to measure the quality metrics
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  and being, hand in hand with the, chief
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  quality officer
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  through that process.
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  But then also being a physician
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  and seeing patients and evaluating them and going
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  through the challenges of frontline work, and then
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  also in the interest industry side,
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  knowing some of the tools that can that
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  can solve some of these problems. And so
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  it's been an interesting mix and seeing what
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  some of the challenges are. To me, it
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  reminds me, you know, of a book, that
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  is very famous that I've read, but really
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  is very true here, Freakonomics,
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  where
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  the way we design incentives is the way
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  people behave.
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  And and our goal I think everyone's goal
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  is to improve patient care. Right? Reduce mortality
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  in the hospital,
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  reduce,
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  any,
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  improper procedures,
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  reduce any accidents, and all those things,
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  which are all great goals to have for
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  patient care.
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  But what we've done through that process is
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  made metrics that I think sometimes conflate
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  good quality of care with
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  administrative burden.
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  So I'll give one example. One is for
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  physicians, one of the requirements is you have
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  to have a history of physical or an
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  evaluation of the patient done and then the
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  documentation done within twenty four hours of that
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  patient being admitted.
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  Now that's relatively reasonable to do and and
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  doable. But what happens is you put so
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  many constraints around that requirement
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  that oftentimes, if someone is not compliant or
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  is that ninety fifth, percentile
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  compliant,
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  they get dinged. And what that really does
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  is just create burnout for physicians because now
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  you're trying to take care of the patient.
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  You're hit with administrative burden while you're trying
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  to take care of the patient. And oftentimes,
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  admission times and I won't bore the audience
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  with some of the details of it, but
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  some of these metrics are are very difficult
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  to measure. And so I think it becomes
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  harder and harder to do some of these
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  things. Another example is discharge times.
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  Across the country, many hospitals have, hey. You
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  gotta have the discharge order in by a
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  certain time of day, like, whether it be
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  11AM, 12PM, whatever it may be. And if
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  a physician puts that order in thirty minutes
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  late,
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  then they are dinged for,
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  lower quality of care.
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  But
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  that delay may have happened because,
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  hey. You got a lab result, and now
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  the patient's,
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  okay to be discharged. Or you're trying to
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  set up a follow-up appointment, you didn't hear
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  back from somebody until later, but you put
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  the order in to avoid them having to
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  stay an extra day.
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  But from the metric standpoint, you were late,
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  and so now you were gonna be dinged
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  for that rather than doing the right thing
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  for the patient, which is helping them discharge
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  earlier
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  and not needing to stay. And oftentimes, what
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  you'll see is you actually increase length of
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  stay because for that very reason is instead
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  of getting a hit from the administrator
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  who's not at all involved in patient care,
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  you're gonna delay the discharge by day so
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  that you can meet the metric. And so
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  what you've seen is
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  these metrics forcing physicians, nurses, and I just
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  gave a couple physician ones, but on the
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  nursing side, it's the same thing in other
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  areas. But you have these these metrics that
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  force people to behave towards the metrics instead
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  of actual real quality. Thank you so much
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  for that overview. And moving forward, what are
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  some of the ways that we could look
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  at this, and
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  how can we improve?
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  Yeah. Chanel, great question. And I wish I
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  had, like, the perfect answer,
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  but I don't. But I will but I
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  will tell you that this is that answer,
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  I think, comes about through several processes. One
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  is
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  everyone has to sit sit at the table
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  together to figure out what makes sense. Because
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  we know what the problem is, but lining
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  up, you know, administrative bonuses
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  with,
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  quality metrics
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  puts them at pressure to then force it
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  onto everybody else. And then you have, nurses,
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  physicians, and, really, a lot of the frontline
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  people, they're not involved in the development of
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  metrics. So I think step one is involve
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  everybody
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  together to come with the right level metrics
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  that helps improve quality and real quality, not
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  just the metrics themselves.
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  I mean, second
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  is don't make this a metric of an
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  individual.
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  Right? I think the the inherent difficulty with
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  some of these metrics is they're placed on
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  an individual
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  with the idea that you're gonna hold somebody
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  accountable. But the problem is that
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  none of these metrics are individually influenced a
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  100%.
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  A discharge,
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  time or order really is influenced as a
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  team because the physician has to make sure
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  that the patient's medically
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  stable enough to discharge.
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  Second, the support team has to make sure
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  that their file appointments are done, that they
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  have the equipment that they need, and so
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  on and so forth. And so all of
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  these things are tied together as a team.
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  And so if the metrics are assigned to
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  one individual,
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  then that individual is held accountable,
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  but has no authority to make the changes,
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  in which case you're you're setting up failure
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  for everybody.
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  And so instead of doing that, make them
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  team metrics or make them metrics that everyone
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  is is able to do,
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  together.
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  And I think some of those processes will
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  improve together. The other thing is, can we
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  make the metric be,
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  things such as readmission,
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  or infection
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  or
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  fallouts or some of those things that are
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  actually real measures of quality. If someone has
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  to come back to the emergency room in
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  three days after discharge, then that's a real
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  quality indicator versus
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  if someone didn't get the discharge order in.
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  That's really irrelevant
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  in terms of, like, the patient care. What's
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  really relevant is,
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  do they get the right medications? Do they
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  get their infection treated? Do they get their
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  surgery done? Do they get whatever they need
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  done
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  and safely, and then they're home safely with
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  the right support system as well with follow-up
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  appointments?
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  To me, those are some of the things
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  that that matter.
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  And having administrators also be held accountable for
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  some of these metrics would help the situation.
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  And it and it has to be team
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  sport because the patient care is a team
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  sport. You can't make the metrics be individually
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  based.
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  Well, doctor Perret, I wanna thank you for
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  your time today. But before I let you
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  go, is there anything else that listeners should
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  know? Oh, Chanel, these are great questions. Thanks
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  for bringing up as a topic.
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  I think in general, what I'd like to
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  say is that these are real real issues
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  that we have to face
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  as, entire health industry to help improve real
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  quality for patients. I think we often get
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  hung up on metrics,
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  which are really separate from the actual patient
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  care for patients. And I think
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  as we put this more and more on
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  the radar, we're gonna get better and better
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  care and really
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  improve our health care for everybody.
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  Oh, that's a perfect place. And, doctor Perron,
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  I wanna thank you once again for your
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  time today and for sharing your insights on
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  the Becker's Healthcare podcast.
• 8:35
  Always a pleasure. Thank you, Chanel.