Patient Reported Outcomes: Why they matter and how to get your patients involved

 

The march toward value-based payments for medical care continues unabated. The Centers for Medicare and Medicaid Services and the Obama Administration mandated that payments to medical providers be linked to quality measures in the form of PQRS reporting and the Meaningful Use requirements for electronic health records (EHR). Actual financial rewards and penalties have already been applied to this reporting. These measures and others are morphing into MACRA in the near future and ever larger financial consequences will apply, whether through the Merit-Based Incentive Payment System or Alternative Payment Models. Some commercial payers have adopted this approach and are actively contracting with private physicians using a variety of value-based approaches to determine payment.

With these mandates come increasing pressure on physicians to more cost effectively manage their patients. Among many efforts to improve quality is the concept of Patient Reported Outcomes (PROs).

With these mandates come increasing pressure on physicians to more cost effectively manage their patients. Among many efforts to improve quality is the concept of Patient Reported Outcomes (PROs). PROs are exactly what they sound like, and contrast with outcomes reporting by a provider of health care. In recent years, more and more academic papers have focused on PROs as an adjunct to objective measure in assessing and managing patient health status. The National Quality Forum has embarked on a project sponsored by the Dept. of Health and Human Services to validate PROs as an instrument for quality improvement and value accountability. Academic and commercial organizations are currently utilizing validated health status surveys as an adjunct to clinical care and research. A review in the British Medical Journal illustrates the potential and increasing adoption of PROs in clinical practice, as well as barriers to adoption among providers.

As more private payer contracts focus on value, more innovative approaches to managing patient populations will become standard practice.

PROs have been developed for numerous specialties and medical conditions, from inflammatory bowel disease to total joint replacements. As more private payer contracts focus on value, more innovative approaches to managing patient populations will become standard practice. In gastroenterology, management of inflammatory bowel disease populations is an obvious target. The Crohn’s Disease Activity Index is the progenitor of more recent PROs tested in pilot programs including the UCLA eIBD project, HealthPROMISE, and Project Sonar. These are all in very limited release at present, and whether they gain widespread adoption won’t be known for some time. One rate limiting step is the ever increasing burden on physician practices to adopt more and newer technology, thus incurring maintenance, training and integration costs. Another approach to getting PRO surveys to patients is using a consolidated platform that has no additional cost or infrastructure requirements. At present, there are scant offerings in this category. Smart Clinic was initially developed as a colonoscopy preparation platform and has evolved to become a multifunctional tool connecting the physician’s EHR to the patient’s mobile device, tablet or computer. Clinical surveys can be fully customized and sent to patients on a schedule. As more demands are placed on practices to trim costs, streamline operations and prove value, consolidated technology tools such as Smart Clinic will become more valuable.

One rate limiting step is the ever increasing burden on physician practices to adopt more and newer technology, thus incurring maintenance, training and integration costs.

For any effort to succeed at proving value in a new medico-economic environment, new approaches will be needed. Numerous studies have shown that engaging patients in their care and adoption of new care models and technologies by patients are most directly impacted by their physician’s recommendation. Therefore, physician buy-in and support is mandatory. After physicians make that operational leap, patients will follow. Only then can the promise of value-based medicine begin to assume all the properties needed to make it successful in the future.