The Users' Guide to the Health Reform Galaxy

Leaving this health reform thread, now.

Maybe Jonathan Cohn has started a trend.

When we began RWJF’s health reform blog, a little over a year ago, we knew we were joining a crowded space.   But the health reform debate touched on so many of the issues that this foundation works on that not joining the conversation would’ve felt, to us, profoundly weird. 

We learned a lot from doing this blog.  It wasn’t the first blog launched from the RWJF mother ship, but it still taught us some new things about blogging in general.  Like, we knew that a ton of our grantees and partners were actively participating and informing the discussions and debates about health reform.  We know this because we were suddenly insanely busy (even more so than usual) putting out a ton of analyses and information from RWJF grantees and partners, and the blog enabled us to put add another layer of thoughtful commentary on top of the high volume of stuff coming from the RWJF fire hose.   However, we also learned that our grantees and partners, for the most part, traffic in groundbreaking research or demonstration projects, and not a lot of them have the time to quickly dash off a conversational, insightful piece.  Only a few had added blogging to their formidably impressive skill sets, and the competition for their thoughts was fierce. 

Nonetheless, we thought it was worth the try to get our own health reform blog going—and we got some good stuff.  We heard from our grantees and staff on a wide range of topics covered by the health reform debate.  We tried to stick, whenever possible, to plain English, so that our few thousand readers would be less confused, perhaps, about particular aspects of the health reform debate.   And now we’re come to a crossroads, and we’re ready to turn in another direction.  This is definitely not the end of RWJF’s blogging days—our Pioneering Ideas blog is still alive, well, and kicking—but we are calling it over for the Galaxy blog.   During the debate leading up to the passage of the law, we joined the conversation in so many ways.  But now the law is passed, and we’re gearing up to join other conversations, and will continue to inform others, with thoughtful and timely analysis and commentary.

Before I turn out the lights, some parting thoughts:

RWJF recently sent out the annual message from our President and CEO, Dr. Risa Lavizzo-Mourey.  This year, her message focused on what just happened, with respect to health reform, and what needs to happen, with respect to health reform, in the years to come.  In RWJF’s ongoing quest to explore the frontiers of interactivity and social media, this year, she invited readers of the President’s Message to submit “one-minute essays,” quick thoughts about what was on people’s minds with respect to health reform.

A ton of responses came through in response to the invite.  And while these responses were meant for Risa alone, she did share some key take-aways with some of us here from the hundreds of e-mails received.  Many respondents shared concrete, thoughtful, detailed responses that showed how people are already thinking several steps ahead about how to implement different provisions of the law.  And, she heard some anxiety in the responses, as well.  Anxiety about what’s in the health reform law, and how whether certain provisions will be implemented well, and successfully, and anxiety about what wasn’t in the law, and whether some important issues in health and health care will simply fall off the radar screen, forever.

I’ve heard a lot of anxiety about the health reform law, too, and can probably rattle off a list of my own worries to add to the mix.  But there are times when I wonder:  gosh, have we become a nation of hand-wringers, or what?  Are we all carrying a Woody-Allenesque flag about our own particular neuroses with respect to health reform?  (“How are states going to handle this?”  “Will people ever understand the benefits of the law?”  “What about public health/addiction/nursing/affordability/mental health/etcetera, etcetera?”)   The Patient Protection and Affordable Care Act, in many ways, is like one ginormous Rorschach ink blot for us all:  we interpret its many provisions according to our own perspectives and experiences, and we project our many hopes and fears onto the law because its passage was, truly, an extraordinary event. 

But I think the wide range of reactions and feelings about the new health reform law tells us another thing, too, and it is this:  a person’s health is shaped by so many different factors.  We as human beings present a vast array of health and health care opportunities and challenges:  where we live, what we eat, where we work, how we think, our genetic make-up, our insurance status, the care we receive, whether we like our doctor, whether enough doctors and nurses live in our neighborhoods, what we read on the Internet….all of these factors can shape a person's health and well-being in this society.  There are so many people out there who care about these different factors.  There are so many people in this country who want to try and influence these factors in ways that actually help people live healthier lives and get the care they need, rather than live sicker and die younger through successive generations. 

This, to RWJF, is what health reform is about.  Health reform has never been about one law, however momentous.  It’s what we do.  It’s our mission.

With that, I thank everyone who contributed to this blog, and everyone who read it, and all of the people at RWJF and elsewhere who took the time to keep it up and running.  It was fun while it lasted—now on to other things.

 

Health Reformer's Lexicon: Federally Qualified Health Centers

The Health Reformer's Lexicon is a weekly feature that will examine key words, terms and phrases in health reform and explore their meaning and orbit.

The term: Federally Qualified Health Centers (FQHCs)

The Centers for Medicare & Medicaid Services provides the following definition:

FQHCs are “safety net” providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Service, and programs serving migrants and the homeless.

Under the supervision of certified medical professionals, like doctors and psychologists, FQHCs offer primary care and preventive services, such as screenings for cholesterol, visual acuity and hearing; prenatal care; immunizations; and mental and nutritional evaluations.

Funded through the Health Centers Consolidation Act, FQHCs must be public or private nonprofit organizations. To receive the designation and qualify for grant funding, they must meet a number of other requirements.

Care can be provided in a number of settings: at health centers, at patients’ homes or elsewhere in the community, and must be provided to all patients regardless of their ability to pay for it.

FQHCs Payments are determined using a sliding fee scale. And as our Health Reform GPS also notes,

… because of their location and high level of treatment of the uninsured, FQHCs receive special payment rates from Medicare, Medicaid and CHIP and are eligible for special supplemental payments from exchange-participating health insurance plans. 

Why it matters: Federally qualified health centers provide care to millions of uninsured, underinsured and non U.S. citizen populations. As access to care expands through health reform, so too will the need for safety net providers. To do so, the federal government will need to work closely with the states to connect people to services and address the primary care workforce shortage.

According to a Health Affairs article, it is estimated that FQHCs will provide care for twenty million people in 2010, about 40 percent of whom will be uninsured. 

Roots: The Economic Opportunity Act of 1964 called for “neighborhood health centers,” which spurred the creation of the first two centers–one in the Mississippi Delta and the other in Boston–in 1965. These early models were based on similar ones in South Africa and also inspired by the American civil rights movement and a growing need to address national poverty issues.

The federal government continued to increase its support for health centers, and eventually created a reimbursement designation–the Federally Qualified Health Center benefit, in 1991. 

More recently, thanks to the support of President Bush’s Health Center Initiative, federal grants for FQHCs increased from $1.1 billion in 2001 to $2.2 billion by 2009, and the number of patients who received care doubled in number. 

Where the term appears: The Patient Protection and Affordable Care Act calls for the establishment of “Teaching Health Centers,” which include FQHCs; it also calls for support to help address the primary care workforce shortage, especially in rural and underserved areas.

The bill also contains $11 billion in funding for health centers, over a period of five years, starting in 2011. According to the National Association of Community Health Centers,

$9.5 billion of this funding will allow health centers to expand their operational capacity to serve nearly 20 million new patients and to enhance their medical, oral, and behavioral health services. $1.5 billion of this funding will allow health centers to begin to meet their extraordinary capital needs, by expanding and improving existing facilities and constructing new sites.
 
Previous Lexicon entries include:
- Value-Based Purchasing
- High-Risk Pools
- Bundled Payments

From a doctor's point of view: making billing better, for better care

James E. Bailey, M.D., M.P.H., is a practicing internal medicine physician, director of the Healthy Memphis Data Center and a professor of medicine at the University of Tennessee Health Science Center.  In this post, he riffs on a topic covered by a recent RWJF-supported study, about how streamlining billing procedures will increase efficiency and help improve the quality and cost of health care.

Between the recession and new health reform law, Americans have been thinking a lot about what health care costs. I’ve heard many stories of patients and their families suffering because of the cost of getting care. I also know many primary care doctors and hospitals that do their best to provide everyone the care they need most are finding it difficult to keep their doors open. Again and again, I’ve seen how the health care people receive is often of poor quality, despite its high, and rising, cost. Sadly, Americans end up getting expensive, sometimes even dangerous procedures they don’t need while their most essential health care needs are overlooked.

The health reform debate tended to focus on big, divisive issues—and rightly so. Real change in our health care system will require hard choices to be made by everyone. But there is another big issue—not quite as divisive but nonetheless worth our attention—which is the system’s misuse of time.  Any physician can speak of large amounts of time—and frustration—spent dealing with administrative issues such as billing. As a doctor, I want most to spend my time with my patients. And so every minute I spend on administrative tasks is one less minute I have for seeing patients. And instead of an efficient system that empowers doctors to best do their work, we’ve created a time hog that dictates the priorities of our practices, inhibiting us from doing what we are called to do as physicians—provide care for those who need it.

This is why reform efforts must address issues like the simplification of billing and paperwork. A new study from RWJF's Changes in Health Care Financing and Organization initiative, “Saving Billion of Dollars—And Physicians’ Time—By Streamlining Billing Practices” suggests that it is possible to streamline the billing process, increase the quality of care and eliminate some unnecessary costs. The study examines the U.S. system of billing third-party payers for health care services, arguing that the system of third-party payment is excessively cumbersome, complicated and costly. We spend about twice as much on the billing bureaucracy in America than in any other country in the world.  While it is unlikely that we will be able to eliminate third-party middlemen from the system any time in the near future, there is much that can be done now.

Health Reformer's Lexicon: Bundled Payments

The Health Reformer's Lexicon is a weekly feature that will examine key words, terms and phrases in health reform and explore their meaning and orbit.

The term: Bundled payments

The RAND Corporation defines bundled payments—also known as “episode-base payments”—as “a single payment for all services related to a specific treatment or condition … possibly spanning multiple providers in multiple settings. Providers would assume financial risk for the cost of services for a particular treatment or condition as well as costs associated with preventable complications.”

The Robert Wood Johnson Foundation and George Washington University’s Health Reform GPS project adds: “In contrast to fee-for-service payments, which can encourage a high volume of treatment, ‘bundling’ is thought to encourage more cost-effective care.”

(Bundling payments first requires categorizing different types of medical cases. These categories are known as diagnosis-related groups, or DRGs, which Medicare uses to bundle reimbursements to hospitals for inpatient care.)

Why it matters: A root cause of many of the U.S. health care system’s most profound problems—including soaring costs and uneven quality—is the fee-for-service payment system, which encourages overuse of health care services and fails to reward value. Among the alternative options, bundled payment schemes are attractive because they give hospitals and physicians incentives to coordinate care and to provide it more efficiently. Tied to evidence-based medical practice, bundling also promises to increase the value of our health care system—producing better outcomes for patients—in a fair and equitable way.

Roots: Physicians at the Texas Heart Institute introduced bundled payments in 1984 for cardiovascular surgical procedures. A 1987 study found that the Health Care Finance Administration could decrease its costs by more than $192 million (13 percent) under Texas’ payment plan. Since then, as U.S. health care expenditures have ballooned, health reformers have continued to advance the idea of bundling as a way to reform the fee-for-service payment system. The Balanced Budget Act of 1997 established new payment systems for most types of post–acute care services; independent initiatives such as PROMETHEUS Payment have worked on the practical design and implementation of evidence-informed case rates; and President Obama championed bundling in the recent health care reform debate.

Where the term appears: The final health reform bill calls for the creation of a national Medicare pilot program by the beginning of 2013, which will develop and evaluate bundled payment systems for acute inpatient hospital services, physician services, outpatient hospital services and post–acute care services for episodes of care that begin three days prior to hospitalizations and last an additional 30 days following discharge.
 
Under the new law, the government must also set up Medicaid pilot projects by 2012 that will use bundled payments to pay for episodes of care that include hospitalizations.

The Centers for Medicare & Medicaid Services is already experimenting with bundled payments through its Acute Care Episode demonstration, with sites in Texas, Oklahoma, Colorado and New Mexico.

And recently, several major health care providers in California announced plans to use bundled payments to pay for hip and knee replacements beginning in August. The lump-sum fee will cover a full range of medical treatments from surgery to 90 days of recovery.
 
Previous Lexicon entries include:
- Flexible Spending Accounts
- Value-Based Purchasing
- High-Risk Pools

Health Reformer's Lexicon: High-Risk Pools

The Health Reformer's Lexicon is a weekly feature that will examine key words, terms and phrases in health reform and explore their meaning and orbit.

The term: High-risk pools

High-risk pools are private, self-funded health insurance plans that serve high-risk individuals with costly pre-existing medical conditions such as cancer or HIV/AIDS.

Why It Matters: As the National Association of Health Underwriters explains, most Americans get their health insurance in group-purchasing arrangements—typically through their employers or the employers of family members—but some people do not have access to this type of coverage and need to buy their own insurance independently.

Unlike in the group health insurance market, however, insurers in most states traditionally have been allowed to deny coverage to individuals with serious pre-existing conditions. That’s because when you buy insurance individually, you’re essentially a “group of one.” The health insurance company has to determine how likely it is to take in more premium dollars from you than it pays back in benefits—and if it appears that the odds are you will get sick, then it is in the insurance company’s financial interest to avoid taking on the risk you represent.

(There have also been widely commented-upon incidents in which insurance companies have found reasons to rescind people’s coverage after they get sick.)

For this reason, many states offer some form of risk pool that individuals can buy into.

Roots: High-risk pools were first implemented in Minnesota and Connecticut in 1976, according to the Kaiser Foundation, and now operate in 34 states, providing insurance to nearly 200,000 people.

Where the Term Appears: The recently passed health reform law established a national high-risk pool program to insure individuals with pre-existing conditions from now until 2014, when the law’s broader provisions for expanding access to coverage begin to kick in. Getting this temporary program up and running is one of the first things that HHS Secretary Kathleen Sebelius has been tackling. She recently sent a letter to governors and state insurance commissioners asking whether they are interested in creating high-risk pools. Some states have responded that they need more time to decide.
 
Previous Lexicon entries include:
- Individual Mandate
- Uncompensated Care
- Value-Based Purchasing

Health Reformer's Lexicon: Value-Based Purchasing … and the latest from Health Wonk Review and Grand Rounds

The Health Reformer's Lexicon is a regular feature that examines key words, terms and phrases in health reform and explores their meaning and orbit.

Today’s term: Value-based purchasing.

According to the Agency for Healthcare Research and Quality, “the term basically refers to any purchasing practices aimed at improving the value of health care services, where value is a function of both quality and cost.” AHRQ continues: “It can be helpful to think about value as the result of quality divided by cost: Value = Quality ÷ Cost. This equation shows that value increases as quality increases, holding expenditure constant.”

The term is commonly associated with specific reforms such as pay-for-performance and discrete initiatives aimed at improving outcomes for a single disease or fraction of the population. But many health care experts argue value-based purchasing must be construed more broadly if it is to be an instrument of systemic reform. For example, the Urban Institute’s Robert Berenson and New America Foundation’s Len Nichols, writing in the Health Affairs blog, offer this definition: “Value-based purchasing uses a variety of tools to try to obtain the right kind and mix of services, of desired quality, at a reasonable cost.”

Why it matters: Susan DeVore, the CEO of the Premier healthcare alliance, has put it this way: “Cutting costs while improving care is the Holy Grail of health care reform.” And in the search for that Holy Grail, many health care policy experts believe value-based purchasing will be a critical tool.

Our current health care system, structured as it is around a fee-for-service model of reimbursement, rewards doctors and hospitals for the volume of services they provide, not the value of the care they deliver for patients or populations. This causes a host of problems, not least of which is overuse of health care services.  In the long run, health care reform can only be successful if the system rewards providers for giving patients the right care at the right time in the right way.

Roots: The concept of value-based purchasing has been gaining currency since the late 1990s as health care researchers and stakeholders have been systematically examining the design, implementation and outcomes of new purchasing strategies to replace fee-for-service.

Where the term appears: The newly enacted health care reform law establishes a hospital value-based purchasing program in Medicare to pay hospitals based on their performance on certain quality measures. The new law also calls for plans to be developed to implement similar value-based purchasing programs for skilled nursing facilities, home health agencies and ambulatory surgical centers.

Previous Lexicon entries include:
- Individual Mandate
- Uncompensated Care
- Flexible Spending Accounts

Meanwhile, in other news …

In this week’s Health Wonk Review on the HealthBlawg, David Harlow mentions our recent post on the definition of uncompensated care, joking that “Titanic doesn't even begin to capture the immenseness of the galaxy” when it comes to this topic. Also, the latest edition of Grand Rounds highlights Catherine Hess’ recent post on children’s health insurance coverage.

Health Reformer's Lexicon: Flexible Spending Accounts

The Health Reformer's Lexicon is a weekly feature that will examine key words, terms and phrases in health reform and explore their meaning and orbit.

Today’s term: Flexible spending accounts (FSAs)

Sometimes called flexible spending arrangements, FSAs are employer-established benefit plans that allow employees to pay for qualifying health care expenses with pre-tax earnings.

Employees elect to set aside a portion of their incomes to pay for medical expenses not covered by insurance—such as deductibles, copayments, dental or vision expenses, or drugs. Employees can draw on the accounts using FSA debit cards, known as Flexcards.

FSAs are “use it or lose it” accounts: Any balance left in an employee’s account at the end of a coverage period—typically a calendar year—is forfeited back to the plan administrator.

Why it matters: As the IRS enumerates, FSAs offer several benefits to health care consumers:

• Contributions made by your employer can be excluded from your gross income.
• No employment or federal income taxes are deducted from the contributions.
• Withdrawals may be tax free if you pay qualified medical expenses.
• You can withdraw funds from the account to pay qualified medical expenses even if you have not yet placed the funds in the account.

But some health care policy analysts have scrutinized FSAs and concluded that they encourage excess utilization of health care, because they can be used to purchase things that may not be medically necessary, cost-effective or provide meaningful health value. Moreover, their “use it or lose it” structure may encourage wasteful spending at the end of coverage periods.

Roots: Flexible spending accounts were first authorized in the Revenue Act of 1978 under section 125 of the federal tax code. For that reason, they are sometimes called “125 plans.” (They are sometimes called “cafeteria plans,” too, because they are a means by which an employer can offer employees a choice between taxable and nontaxable benefits—not just for health care, but also for dependent care or certain other purposes.)

Where the term appears: The recently passed health care reform law limits the amount that employees and companies can contribute to FSAs to $2,500 per year starting in 2013, with annual cost-of-living adjustments in following years. (Unlike FSAs for dependent care, there was previously no federal cap on the amount that could be contributed to FSAs for health care.) Recent news reports have examined the impact of this for consumers, suggesting that people may want to plan costly elective treatments such as braces before the new limit takes effect. Coverage also has delved into the rationale for the policy change—which some portray as a way to reduce wasteful spending and others portray as a way to raise revenue to pay for other aspects of health reform.

Previous Lexicon entries include:
- Patient Centered Medical Home
- Individual Mandate
- Uncompensated Care

What just happened? Still processing.

I spent some time with the actual pages of PPACA this week (in my opinion, you can either pronounce it to sound like a town in upstate New York, or adopt a slight stutter), because I was getting the uneasy feeling that just reading those nifty summaries and implementation timelines that everyone's circulating might not be enough (this reminds me of how I try to resist opining on movies based on just reading the reviews).  I had to track down the one person at RWJF who had been brave enough to print out the entire law, plus the reconciliation amendments; then I started cautiously sifting through the table of contents to see what I could find.  It is not a task for the fainthearted.  Secretary Sebelius announced a "help desk" to guide Americans through the law but I always feel some obligation to learn on my own before I start bothering those nice people someone puts at my disposal to help me somehow muddle through.  Clearly, this is going to take some time.  But I found one thing to be oddly comforting as I wended my way through pages of text; it took me years of working at RWJF to truly understand that health results from so many different ingredients, including, but not limited to, personal health behaviors, environment, housing, insurance status, and the quality and type of care one receives.  It's impossible, once you really steep yourself in what it takes to make people healthier and get them the care they need, to believe that any one solution will do the trick for any one problem.  And so, as I was trying to dip my toe just a wee bit into the PPACA waters, I did think to myself, "Oh.  They got that."

Health Reformer's Lexicon: Uncompensated Care

The Health Reformer's Lexicon is a weekly feature that will examine key words, terms and phrases in health reform and explore their meaning and orbit.

The Term: Uncompensated care

Researchers from the Urban Institute define it as “medical care that is either freely donated by providers or results in an unpaid bill.”

The American Hospital Association defines it in more exacting detail as “the sum of a hospital’s ‘bad debt’ and the charity care it provides.” AHA elaborates:

In terms of accounting, bad debt consists of services for which hospitals anticipated but did not receive payment. Charity care, in contrast, consists of services for which hospitals neither received, nor expected to receive, payment because they had determined the patient’s inability to pay. In practice, however, hospitals have difficulty in distinguishing bad debt from charity care.

Why It Matters: In most cases, uncompensated care is provided to people without insurance. One estimate pegged the amount of uncompensated care given to uninsured people in America at more than $50 billion a year. Government underwrites more than $40 billion of it through Medicare and Medicaid Disproportionate Share Hospital (DSH) payments and other means.

Health-policy experts have argued that failing to enact reform would have led to greater levels of uncompensated care, perhaps even double the amount. Conversely, analysts have estimated that by insuring tens of millions more people, reform will dramatically decrease uncompensated care—and thus provide substantial spending offsets for federal and state governments.

Indeed, the final reform bill signed by President Obama reduces Medicare DSH payments by 75 percent and then begins adjusting them based on the percentage of the population uninsured and the amount of uncompensated care provided. Medicaid DSH payments are set to be reduced, too.

Roots: It is difficult to pinpoint precisely when the term “uncompensated care” was coined, but a January 1974 article in the American Society of Law & Medicine’s Medicolegal News hints at its origins:

When the Hospital Construction and Survey Act of 1946, more popularly known as the Hill-Burton Act, was passed by Congress, facilities receiving federal funding were required to assure that they would provide a “reasonable volume of services to persona unable to pay therefor.” The general legislative intent was that this would help provide access to medical care to a segment of the population that had hitherto been denied care or had been reluctant to seek it because of lack of financial resources…

As became increasingly apparent throughout the next two and one-half decades, many hospitals treated the statutory mandate to deliver uncompensated services as mere surplusage. If they were required to account at all for the volume of uncompensated care provided, they simply wrote off their bad debts for the year as Hill-Burton qualifying services…

Where the Term Appears: An expected drop in uncompensated care is factored into the final health reform law in the form of the aforementioned cuts to Medicare and Medicaid DSH payments. The term—and the dollar figures associated with it—also continue to appear in post-game analyses and debates about the costs, benefits and fallout of enacting reform.

Previous Lexicon entries include:
- Meaningful Use
- Patient Centered Medical Home
- Individual Mandate

Health Wonk Review: Brand New News

After a month of “March Madness” in the world of health care reform, we start off April with new legislation and a new edition of the Health Wonk Review, posted over on Healthcare Technology News. This week’s roundup includes two posts from our blog on providing support to primary-care practices for quality improvement and the work that’s far from over.

Moving the Needle on Kids' Enrollment in Public Insurance Programs

Today’s post comes to us from Catherine Hess, Senior Program Director at the National Academy for State Health Policy (NASHP) and Program Director, Maximizing Enrollment for Kids.

Too often, when trying to address problems in our society, we look for a silver bullet – one solution. To the casual observer, last year’s passage of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) might seem like a silver bullet for the problem of uninsured children. Unfortunately, while public insurance programs like the Children’s Health Insurance Program (CHIP) and Medicaid theoretically extend coverage to a wide swath of the uninsured, many who are eligible are not enrolled in these programs.

But we know from research and over a decade of experience with CHIP that there is no silver bullet. There are multiple key strategies, and to be effective, they need to be tailored to different state and local circumstances.

To that end, the National Academy for State Health Policy (NASHP) collaborated with the Robert Wood Johnson Foundation (RWJF) to launch Maximizing Enrollment for Kids, a four-year, $15 million national program that helps states tailor and adopt key strategies to improve enrollment. Our ultimate goal is to “move the needle” to cover many more uninsured children, and we are documenting and sharing what works as we go along. 

We received applications from over half the states for this program, a positive sign of their interest. Eight states demonstrating commitment and vision to maximizing enrollment of eligible, uninsured children were selected: Alabama, Illinois, Louisiana, Massachusetts, New York, Utah, Virginia and Wisconsin.

If this program is successful – and so far, so good – these states will increase the efficiency of their systems. But another simple but particularly remarkable point is that as they improve systems, these states will spend more on covering additional children. Think about that. Even in a nasty budget climate, states want these programs to function at their top potential. This is highly encouraging.

Rx for Primary Care

Sheldon D. Horowitz, M.D., a special advisor to the president of the American Board of Medical Specialties and principal investigator of the Improving Performance in Practice (IPIP) initiative, writes about an effort to give small physician practices the tools they need to improve quality.

Today is National Doctors Day, a day set aside to thank physicians for all they do in applying modern medical science and technology to the special calling of preventing and treating people’s injuries and illnesses. It seems appropriate, then, to recognize a program devoted to helping doctors in primary-care practices do that more effectively.

The program, called Improving Performance in Practice (IPIP), provides practices with tools, support, coaching and a collaborative learning environment in which they can assess their performance and engage systematically in quality-improvement activities using their own practice data. Doctors can also compare their data to others in their cohort groups as benchmarks.

As everyone involved in quality improvement knows, translating the latest and best medical techniques and protocols into practice is easier said than done. That’s especially true for the small offices where 60 percent of U.S. physicians work. Compared to big hospitals and integrated group practices, they typically have fewer resources available for quality-improvement efforts. IPIP fills the resource gap for small practices in seven states by giving them process-improvement kits based on the Chronic Care Model and providing quality-improvement coaches, typically registered nurses, to guide practices through the steps involved in taking full advantage of the program’s resources.

To enroll, practices choose a focus area—asthma or diabetes in most cases—and commit to using a registry or electronic medical records to manage their patient populations, if they don’t already. Then they begin providing monthly data on a set of quality measures covering care processes and outcomes.

Such measurement and reporting are essential. As one Colorado doctor told IPIP staff, “Until I saw my data, I thought I was providing excellent care. Now I see we have a lot of work to do.”

Among other things, coaches help practices improve their division of labor and work flow by relentlessly asking the question: “Is this physician work or non-physician work?” If a doctor isn’t needed for a particular task—say, administering an annual sensory exam to diabetics to test for nerve damage—then someone else in the office should take care of it so doctors can focus on the things that only they can do. These work-flow improvements help practices get more done—and also improve job satisfaction. “I was considering leaving the profession,” Dr. Tracy Hofeditz of Lakewood, Colo., told IPIP staff. “But now I have rediscovered the joy of practicing medicine.”

One key benefit of participating in the program is that it helps practices comply with ABMS Maintenance of Certification®, professional recognition for quality and pay-for-performance programs.

Patients, meanwhile, get more effective care. For example, in the 16-month period between June 2008 and October 2009, Pennsylvania IPIP practices saw a 15-percentage-point increase in the share of diabetes patients with blood pressure of 140/90 or less—an important threshold level to stay below.

That kind of success helps explain why IPIP, which began as a small pilot program in Fall 2006, has quickly grown to serve more than 350 practices with 1,400 doctors and 350,000 asthma and diabetes patients from Colorado to North Carolina.

For more about IPIP, which is sponsored in part by the Robert Wood Johnson Foundation and convened by the American Board of Medical Specialties, download a copy of its recently released program brief.