Regardless of intentions, the reality is unnecessary care takes a significant toll on both the overall system and individual health consumers. It drives costs and puts patients at risk for complications, longer hospital stays, and even death.
Clinical judgment is vital to the delivery of high-quality healthcare. Providers rely on best-practice guidance, quality measures, and their own experience to make decisions on a case-by-case basis. However, the anemic quality measures that exist today focus primarily on treatments, diagnostic tests, or surgeries where there is a clear right or wrong approach. (For example, never use whole-body scans for screening.) The challenge for clinicians – and the system as a whole – is that when it comes to clinical judgment, there is little guidance in regards to appropriate care.
Practicing Wisely™, a collaboration between Oliver Wyman and Marty Makary, MD, takes a new approach and aims to reduce unnecessary care, improve patient outcomes, and lower costs by providing clinicians with appropriateness measures.
How? Practicing Wisely measures practice variation in like-physician cohorts (those in the same specialty and sub-specialty, doing the same types of procedures) and identifies extreme outlier physicians – that is, physicians who consistently deviate from physician-endorsed guidelines and the practice patterns of their peers. Practicing Wisely then helps leadership develop and deploy interventions designed to change practice behavior and reduce practice variation.
By analyzing practice behavior down to the individual clinician level, organizations can take meaningful action to reduce unwarranted care.
Practicing Wisely focuses on provider behavior in cases where clinical judgment is involved. For example, how does a clinician treat patients with chronic back pain: surgery or continue with physical therapy? Is hysterectomy performed via open surgery or laparoscopic procedure?
By analyzing claims data, Practicing Wisely identifies physicians whose practice behavior routinely falls outside best-practice guidelines and the average of their peers.
Practicing Wisely uses a library of physician-approved measures to assess practice variation for specific medical procedures. Practicing Wisely also leverages Oliver Wyman’s infrastructure of big data analysis, actuarial cost validation, clinical review, broad healthcare perspective and a broad set of industry stakeholders.
The intention of Practicing Wisely is not to question providers’ clinical judgment on a specific case, but rather to ask why, for outlier physicians, their practice patterns differ so dramatically from their peers. Ultimately, change is in the hands of providers. By making variance in practice behavior more transparent, with visibility to how physicians’ practice patterns compare to their peers, both organization leaders and individual clinicians will understand who is outside of the best-practice norm.
Consider diagnostic angiographies:
1What has been the biggest surprise for you while developing Practicing Wisely?
The level of enthusiasm for developing quality measures that are tied to practice variation. We have run into countless physicians, administrators, and other stakeholders who have a passion for improving the quality of care, specifically by reducing unnecessary and inappropriate care. It has been rewarding to see how appreciative people are towards our measures and insights into individual physician performance.
2What makes Practicing Wisely different?
First, we evaluate clinical decisions that involve judgment. Most measures evaluate outcomes with clear right/wrong answers. Unfortunately, most of medicine is not right/wrong or always/never. The large majority of medicine involves judgement, and that’s where Practicing Wisely focuses. Second, our measures are developed in partnership with physicians. Consensus building among physicians can be difficult, but it has been critical to our success. Finally, our program enables organizations to change by providing reports with actionable insights at the individual physician level.
3Is all variation bad? In other words, could you be reducing necessary care?
We do not intend to question a physician’s decision treating specific patients; instead we ask why a physician’s clinical judgment – in aggregate – differs so much from his or her peers. Ultimately, medical decisions should be made by physicians. Our hope is that we can provide sufficient transparency in practice behavior to help physicians make more informed decisions.
If you would like to learn more about Practicing Wisely, contact Jim Fields at Jim.Fields@OliverWyman.com.