Rethink Centers of Excellence

I'm sure you work in a Center of Excellence (COE). Unfortunately, it is probably neither a center nor excellent as judged by independent evaluators of quality and cost or payors.

Here's an example of COEs in spine surgery. Guess what?

Promoting yourself as a center of excellence might be good marketing or helping to build your brand, but it many instances, it is disingenuous at best and a fabrication unsubstantiated by data at worst. Why?

1. It is extremely difficult to be in the top 10% of value (quality/price) -my definition of excellence- in any one specialty, like oncology or orthopedics, let alone several
2. Care teams take care of patient teams. We should be measuring teams of excellence, not facilities of excellence
3. Surgeons of excellence belies the fact that many, many people who touch the patient along the care pathway other than the surgeon are significantly more responsible for the outcomes, for example bariatric surgery or cochlear implant surgery, which require long pre- and postop periods of education and rehabilitation
4. The present methods of measuring surgical excellence are incomplete
5. New models of care are creating more and more challenges to insuring continuity of care, continuity of care information and care coordination. As a result, more and more people are involved in the "center of excellence" and many of them have never seen or touched the patient.
6. A center implies that you are providing one-stop, interdisciplinary, interprofessional care, similar to what the Mayo brothers had in mind many years ago. Just because you do a lot of one operation in a given facility does not justify calling it a COE. Rather, you need to earn that designation based on outcome quality and cost analysis and ranking
7. We are obsessed with sick care process and structure policies, procedures and compliance mandates madness. Many of these are not valid surrogates for outcomes.
8. Patients will need to take more and more responsibility for taking care of themselves. Many are either unwilling or unable to do so and we need to provide them the tools and use behavior change techniques to help them contribute to their own better outcomes. The 5% that are responsible for 50% of the spending is the obvious low hanging fruit.
9. EMRs need to change to adapt to measuring outputs, not inputs
10. Data analytics should help us truly separate the wheat from the chaff.

We need to stop the doctor beauty pageants. We should also put a fork in COEs.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs