By Christine Goertz, DC, PhD
Long before many of us can remember, there were only two people sitting in the chiropractic treatment room – the patient and the doctor. Gradually, the state licensing boards starting showing up. They were joined by the insurance industry. Then health policy makers like Medicare and Medicaid. Followed by more members of the insurance industry. Then scientists made an appearance, talking about evidence-based clinical practice. Now this already very crowded room may become even more crowded if we open the door to the ever-loudly-knocking performance measurers. We have had time to get at least somewhat used to the state and national boards, insurers, policy makers and even the scientists, to some extent. But what is performance measurement and how might it be beneficial to the practice of chiropractic?
First, what is performance measurement? The Health Services Resources Administration defines performance measurement in health care as the “regular collection of data to assess whether the correct processes are being performed and desired results are being achieved.”1 In other words, collecting data to determine if one is following processes that are associated with best clinical practices and if those processes are leading to excellent clinical outcomes.
Clinical data registries are often used for the purposes of collecting this data.2 An example can be found by looking at two of the performance measures included in the 2017 Spine IQ Conservative Spine Care Qualified Clinical Data Registry.3 Measure 182 tracks whether or not you are following the “correct processes” by assessing the “percentage of visits for patients aged 18 years and older with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool on the date of the encounter AND documentation of a care plan based on identified functional outcome deficiencies on the date of the identified deficiencies.”4
This is a process measure because it is simply looking at whether or not the patient filled out a questionnaire asking about their level of physical functioning and whether that information was considered in developing a care plan. It does not address actual patient outcomes themselves. Therefore, its companion is Measure SpineIQ1, which is needed to determine if “the desired result is achieved”. It is an outcome measure designed to assess the ”Average percent change in functional outcomes assessment between the first date of a care encounter and each qualifying follow-up assessment during the reporting period for patients aged 18 years and older with a diagnosis of neck or low back pain.”4 In summary, Measure 182 looks at whether or not the patient is completing a questionnaire regarding their current state of physical functioning and Measure SpineIQ1 looks at their actual level of physical function.
Clearly, there is some additional work involved in performance measurement. Why bother to open that door? Below are 11 reasons why you might want to consider inviting this additional guest into your treatment room.
1. Facilitates discussions with potential referral sources who are considering alternatives to opioid use but are unfamiliar with or have a bias against chiropractic.
2. Allows you to identify gaps in clinical outcomes and/or processes that you may not know exist by benchmarking yourself against your peers.
3. Builds the cultural authority of the chiropractic profession through participation in nationally recognized performance measurement programs such as the CMS Merit-based Incentive Payment System (MIPS) program.
4. Increases opportunities to participate in integrative health care systems such as ACO’s and Patient Centered Medical Homes, as either part of a group practice or “virtually.”
5. Allows us to step over philosophical differences regarding treatment approach by focusing on universally accepted interdisciplinary patient care processes and outcomes.
6. Allows us to fully leverage the current national interest in patient centered outcomes, an area in which chiropractic has always excelled.
7. Allows us to build data bases that can begin to identify real world best practices based upon real patient outcomes rather than utilization data alone.
8. Can be used to support the need for continued chiropractic care when claims are inappropriately rejected by payers.
9. Enables us to identify specific patients who are or are not responding to care and identify patterns based on baseline characteristics that may be easier to identify when you look across similar patients.
10. Provides transparency by letting patients, payers, purchasers and other stakeholders know what to expect when receiving care in your office.
11. Ultimately, for all of these reasons above, leads to better quality patient care.
Dr. Goertz is senior scientific advisor for the ACA. She also serves as vice chancellor for research and health policy at Palmer College of Chiropractic and CEO of the Spine Institute for Quality (Spine IQ).
1. "Performance Management and Measurement," Health Resources and Services Administration, www.hrsa.gov/quality/toolbox/methodology/performancemanagement/
2. "What Is a Clinical Data Registry?" National Quality Registry Network, http://www.abms.org/media/1358/what-is-a-clinical-data-registry.pdf
3. Spine IQ, www.SpineIQ.org
4. "2017 Performance Outcomes," Spine IQ, http://www.spineiq.org/what-is-spine-iq/outcome-measures