The Group Practice Improvement Network (GPIN) celebrated its 25th anniversary this year. Started in 1993 by the founders of the Institute for Healthcare Improvement (IHI), GPIN exists to help medical groups “achieve and sustain performance excellence by sharing knowledge of best practices.”
With approximately 100 multispecialty medical groups counted among its members, GPIN’s semi-annual conference in Rhode Island (May 1-3) offers a wealth of information on how best to improve quality, increase patient satisfaction and lower costs.
Under the outstanding leadership of Kate Upton, the Executive Director, this year’s program welcomed more than 300 participants. Every person with whom I spoke, regardless of title or role, was eager to bring the conference’s teachings back to their organizations.
I was invited to deliver the keynote address on May 2 on “The Future Of American Healthcare,” focusing specifically on what actions need to happen to reverse the troubling decline in American life expectancy and the quality of our nation’s healthcare. In my hour-long presentation, I described a dozen opportunities to simultaneously improve quality and make care more affordable. Each of these I implemented during my time as CEO in Kaiser Permanente. Here are five of them:
1. Provide a comprehensive electronic health record at every point of contact. That’s how The Permanente Medical Group moved from middle of the pack to No. 1 in quality, according to NCQA rankings and Medicare star ratings. To prevent strokes, heart attacks and cancer, and maximize outcomes when providing treatment, clinicians need complete and immediate access to patient medical information. Without it, the risk of medical error rises precipitously.
2. Move from a five-day hospital to a seven-day hospital. In the United States, patients admitted on a Friday night spend, on average, a full day longer in the hospital than those admitted on a Tuesday—even when they have the same diagnosis. To avoid delays that lead to lower quality, poorer service and higher cost, hospitals must staff appropriately seven days a week. In my experience, it can be done without adding costs.
3. Provide specialty expertise immediately. Doctors can improve quality outcomes, care coordination and the patient experience with one simple action: Connect primary care and specialty physicians when patients are still in the primary care doctor’s office, rather than sending them to the specialists at a future date. As an example, using digital technology at Kaiser Permanente, 70% of rashes that primary care physicians would otherwise have wanted a dermatologist to evaluate and treat in person, were addressed in a matter of minutes, not weeks. The approach allows the primary care doctor to resolve the patient’s problem immediately, avoiding delays and redundant care, while decreasing specialty visits by 30% to 40%.
4. Set quality excellence standards for surgical volume. Instead of establishing minimal standards, department leaders should determine the number of procedures a physician needs to do each year to achieve superior quality outcomes. Across the U.S., as many as half of the physicians performing hysterectomies, total joint replacements, thoracotomies and gastrectomies don’t do enough procedures each year to maximize results and minimize complications. The same expectations should apply to hospitals, so that each of the OR teams has enough experience to achieve the best outcomes for patients. That will mean closing low-volume services.
5. Rebalance the ratio of primary care and specialty physicians. To right-size the American healthcare workforce, the United States must be willing to learn from higher-performing countries with superior outcomes. All of the best healthcare systems in the world have a far greater percentage of primary care physicians than in the United States. To right the ratio, we need to increase the dollars spent on primary care from the current 4-5% to 6-7%. Though a 2% difference may seem small, it would allow higher salaries, added support staff and smaller panel sizes. The added dollars would rapidly be recouped by fewer hospital days and the need for fewer specialists.
Across the United States, multispecialty medical groups are leading the way, finding better ways to provide medical care, use technology and maximize patient safety. Most of the cutting-edge medical groups in the country were at the GPIN conference, sharing ideas and learning from each other. I’m confident that when they come back next year, their ideas and approaches will be even better and more successful.
Medical groups who are not yet members should consider joining.
Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him on Twitter @RobertPearlMD.
