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Case Study: Ambulatory Practice

Situation:

  • Hospital system owned physician practice sites
  • Contractual agreement with physicians requires evaluation of physician performance as prerequisite for compensation adjustments annually
  • Oversight of the quality of the office practices of these physicians needed yet local peer review capability limited for anticompetitive and confidentiality reasons
  • Healthcare system seeks to be more effective in attracting and retaining managed care contracts necessitating the ability to demonstrate the results of efforts to continuously improve the quality of care and service of its ambulatory practice sites
  • Budget is limited, solution must be supportable internally with limited external support

QMCG Team Role: To design and assist in the implementation of an ambulatory care QA&I system and provide consultation and external review of the quality of medical care provided on an as needed basis including:

  • Development of a Practice QA&I Committee composed of practice physicians, other representative clinicians and the Practice Manager
  • Regular peer review by the Committee using QMCG review tools
  • Trending of results
  • Identification, prioritization and management of systems improvement opportunities using the CQI process
  • Ongoing availability of a selected external peer review physician for medical record review and telephone consultation as needed

Healthcare System/Practice Accomplishments:

  • Currently implementing an ongoing multidisciplinary QA&I system
  • Training of the practice team
  • Accessibility for clinicians and practice management to telephone consultation with a qualified non-competitor physician of the same specialty
  • Demonstrable evidence of the practices' commitments to continuous improvement of care and service
  • A mechanism for the ongoing evaluation of provider clinical performance
 
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