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The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality
Robert Coulam1, John Kralewski, Bryan Dowd
1Robert Coulam, PhD, JD, is Professor of Practice in Health Policy and Management, Simmons College, Boston, Massachusetts. E-mail: coulam@simmons.edu. John Kralewski, PhD, is Senior Research Fellow, Medica Research Institute, Minnetonka, Minnesota, and Professor Emeritus University of Minneapolis, Minnesota. Bryan Dowd, PhD, is Professor, University of Minnesota, Minneapolis, Minnesota. David Gans, MS, ACMPE, is Senior Fellow Industry Affairs, Medical Group Management Association, Englewood, Colorado.
Background:
Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators.
Purpose:
To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States.
Methodology:
We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues.
Findings:
Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators' recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare's PQRS reports impeded use of the data by administrators to support quality management.
Discussion:
Group practice administrators are playing a prominent role in activities related to the quality of patient care--they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results.
Practice Implications:
More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if supported by more useful forms of quality reporting.
Insights
Medical group practice administrators play a key role in adopting quality assurance programs. While they facilitate implementation, complex reporting hinders data use for quality management.
Area of Science:
- Healthcare Administration
- Medical Group Practice Management
- Quality Improvement Initiatives
Background:
- Limited research exists on the specific role of group practice administrators in quality assurance (QA) program adoption.
- Existing studies primarily focus on factors influencing QA adoption without highlighting administrative influence.
Purpose of the Study:
- To investigate the pivotal role of medical group practice administrators in the adoption and implementation of quality reporting systems.
- To analyze how administrators influenced the uptake of the Medicare Physician Quality Reporting System (PQRS).
Main Methods:
- Conducted focus group interviews with 76 medical group practice administrators nationwide in 2011.
- Analyzed administrator responses using the innovation decision framework by Van de Ven et al.
Main Results:
- Administrators actively managed PQRS adoption, influencing physician buy-in and overseeing implementation.
- Key influences on administrator recommendations included practice characteristics, financial incentives, and commitment to quality improvement.
- While PQRS implementation was generally straightforward, complex reporting formats impeded administrators' use of data for quality management.
Conclusions:
- Group practice administrators are integral to patient care quality activities, extending beyond business operations.
- Medicare should actively engage administrators in shaping quality reporting programs and simplify data utilization for them.
- Further research is needed on the evolving role of non-physician administrators in medical practices and their impact on quality reporting initiatives.
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