How to give a surgeon the bad news

Thanks for coming in today, Dr. Meyers. How was your weekend? (the pause before dropping the hammer)

M:Fine, thanks. Yours? (already suspicious)

Good. We spent some time in the mountains where it was a bit cooler.(enough with the small talk). I called you in today to review your quality reporting ratings results. As you know, it is very difficult to measure surgical quality but we hired a firm to look at the results of our surgeons based on a number of criteria, both qualitative and quantitative and rated our surgeons for quality. You have had exceptionally good patient feedback scores, but, unfortunately, your outcomes are below the 75th percentile. We really appreciate all you do for us and want to help you improve your scores (kiss 'em, kick 'em, kiss 'em).

M: Seriously? Are you sure you are measuring the right things? I'm pretty sure my outcomes are much better than many of the other surgeons in the department?

How do you know that?

M: I haven't had complaints and all you have to do is come to see me operate and ask my colleagues about my surgical technique.

We realize that measuring surgical quality is not an exact science and that there are some gaps in our analysis. However, even factoring for that, while we do not disagree that you are practicing the standard of care, I would like to discuss how we might help you improve?

M:The first thing you can do is stop bugging me about all this measurement stuff and just let me go back to taking care of my patients. How do you expect me to generate RVUs and make my numbers when I have to waste time with you talking about this? Besides, if you did a better job costing and pricing our bundles, we could be a lot more competitive. Seems to me it's the pot calling the kettle black.

Well. as you might be aware, we are getting paid more and more for bundled surgical services that deliver value and that means delivering more quality/price compared to everyone else in our catchment area. We all have to pull the oars in the same direction, you know.

M: As far as I can see, I'm still getting paid to generate RVUs and all that value stuff is really years away despite what people who have never seen a patient are telling us. Besides, you just sent me a report saying how satisfied my patients were with their care.

While that might seem to be your perception, in fact we are rolling out a new system to measure value and will base our physician compensation system, in part, on results. Plus, patient satisfaction with their hospital stay is not proxy for surgical quality.

M: So what do you expect me to do?

We will be providing you with monthly reports that compare your results with the other members of our department (name and shame). Of course, the data has been risk stratified and compared to a national standard developed by national surgical and specialty societies. We are sure that you are interested in improving your outcomes and look forward to working together to assure our patients are getting the best care.( in other words, we will be paying several FTEs to do the coding and reporting work).

Also, we understand that you do many of your cases in a free standing ambulatory surgery center where there is no EMR. That has to change because we can't capture the data we need to compete for value based surgical services that our self insured employers want.

M: I have been practicing here for three times as long as you have been counting beans. Besides, there are not a lot of specialists interested in working here who have my experience. ( I dare you to find someone and their spouse who is willing to live in this remote part of the state)

Thank you very much for your time. We will be contacting you outlining the next steps in the process of assuring surgical quality and patient safety.

I'll let you get back to the OR now. Once again, thank you for your dedication for the many years of service on our medical staff. If you'd like, I'd be happy to make an appointment with our HR person to provide you with future career development opportunities (use a bunch of euphemisms for it's our way or the highway).

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@ArlenMD and Co-editor of Digital Health Entrepreneurship