Van Duren: Doctor-Led, Data-Driven Variation Reduction

Michael van Duren, MDOne of a series of reports on the October 21 MMS forum, “Toward a Shared Vision of Payment Reform.”

Physicians tend to be disgruntled with most of the data they get from insurance companies, partly because much of it is used to pigeonhole them into often-inaccurate efficiency-based performance categories.

But at the recent MMS payment reform conference on October 21, Michael van Duren, M.D., chief medical officer at Sacramento-based Sutter Physician Services, explained how he facilitates discussions among small groups of physicians using drill-downs of such data to uncover and resolve variations in care.

“Data that’s used and displayed differently than how insurance companies provide it can be very actionable,” Dr. van Duren said.

To prove his point, he took the audience through two sample “explorations” using Sutter’s Care Pattern Analyzer, an Ingenix-driven, episode-based tool containing data on individual physicians as well as groups and regions.

In one example, the average cost of an episode of chronic sinusitis without surgery varied from $300 to $600. Using facilitation skills that he characterized as the trickiest part of the variation-reduction exercise, Dr. van Duren led a small group of physicians in discussions to determine why such variation existed. Often, there are patient-specific and clinically important reasons for the variations, but sometimes, as these conversations determine, it’s a matter of ingrained practice patterns.

Discussions about low-cost physicians almost always lead to debates over outcomes, data that insurance companies typically can’t or don’t deliver, but which physicians can discuss meaningfully.

“When physicians explore this without judgment in a safe, respectful environment, they learn a lot and sometimes make improvements to clinical practice,” Dr. van Duren said. It’s not an insurance company edict, but a thoughtful consensus among peers, all of whom want to do right by their patients.

Dr. van Duren described another doctor-led analysis that resulted in a 20-percent reduction in imaging rates for patients with low back pain of less than 30 days duration and no indication of cancer. “There can be losers in this,” Dr. van Duren admitted. “If you have a financial interest in a radiology center, this could be uncomfortable.”

Video excerpts of his presentation:

Download his presentation. (.pdf, 18 pages)

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