Figuring out how to gauge quality

In our last issue, Independent Practitioner Today reported that the Private Healthcare Information Network (PHIN) had been approved by the Competition and Markets Authority as the information organisation charged with publishing performance measures and fees for independent hospitals and consultants in private practice. Matt James outlines what to expect next

doorPHIN has started 2015 with renewed energy and focus. We spent much of last year working towards approval as the Comp­etition and Market Authority’s (CMA) information organisation and now we have won the role, it is time to turn our full attention to delivery.

It is quite a task.

Over the course of 2015, we must somehow reach out to around 12,500 consultants and get them involved. So, firstly, let me say that we are very grateful to Independent Practitioner Today for helping us make a start.

As a quick reminder from previous articles I have written in this journal, the CMA’s remedies require that all private hospitals in the UK – including day surgery centres, cosmetic specialist hospitals and NHS private practice units – collect and send to the information organisation detailed data in specific formats.

Information required

These cover 11 mandated performance indicators, from activity levels through re-admission rates to patient-reported outcome measures (PROMs) and patients’ satisfaction rates.

They must support publication at hospital and consultant level, meaning that you will probably want to get involved in making sure that data produced about you, your hospital and your specialty is accurate, fair and meaningful.

Publication across the whole range of measures is required by April 2017, which, in practical terms, means that hospitals will need to be collecting data in a compliant format from January 2016, so that we have a full year to measure. Volumes are already low in many areas – anything less than a year just is not enough.

That leaves a fair bit of preparation work for hospitals to do in 2015. Key tasks for most will include implementing better coding for private patient records to match NHS standards, and implementing collection of PROMs for private patients.

Both of those are good news for consultants: better coding means the ability to apply case-mix standardisation and risk-adjustment to performance measures for the first time, while PROMs will need to be extended beyond where the NHS has taken it to be able to report outcomes for individual consultants.

If done right, PROMs offers an affordable and attainable way to differentiate from the NHS. Those two changes will give you new tools to demonstrate the quality of your practice.

Case-mix adjustment is, of course, part of ensuring that information is fair and representative of your practice. Along with related concerns such as sample sizes for low-volume procedures and part-time or new practitioners, this is one of the two areas on which I now expect a thorough grilling when I speak with consultants, particularly at professional meetings.

The use of ICD10 diagnostic coding and related tools such as the Charlson score will be a start.

Work with experts

We cannot know just how effective they will be until we have got a body of data. You may already record other factors such as body mass index or ASA score that could also be taken into account, and we will have to work out how to gather and use such information.

The relevant factors may well vary by specialty.

Frankly, on low volumes and other such concerns we do not know what the answers are yet. We will need to both look at data and work with experts, from specialty associations to statisticians, to find the best approach.

What I can say is that PHIN will not advocate the publication of meaningless or unfair data: by no means will every measure be applicable for every specialty and consultant for every procedure.

But we must work together to find ways to give every consultant some opportunity to demonstrate the quality of their practice through comparative data.

The second area of common concern is around PHIN’s governance. Consultants often challenge me about the influence of the insurers (very little, to date) and about members of our board.

I understand the concerns, but the CMA has ensured that our board will end up balanced and broadly representative of the sector, with two non-executive directors of their choice included to guarantee fair play.

Now that we have an official role, there will be a great deal of scrutiny and transparency applied to the way we work and I hope that any remaining concerns will ease over time.

PHIN meetingsIn late November, I was delighted to be invited to speak at Nuffield Health’s National Med­ical Advis­ory Committee (MAC) Conference, with the opportunity to address a mixed audience comprising mainly MAC chairmen and hospital directors.

Invigorating conference

My talk was one of four or five aimed at helping attendees to understand the CMA’s remedies from various angles – legal, regulatory, clinical and commercial in addition to information – to be able in turn to help their colleagues back in the hospitals.

It was an invigorating day. Nuffield Health’s commitment to helping their consultants to understand and respond positively to change was bettered only by their focus on the patient, both as patient and customer, which I found exceptional.

I believe that the consultants in the room understood clearly how a better product for patients might also mean a healthier practice for them.

One of the MAC chairmen raised the issue of how he might produce effective whole-practice information to support appraisal and revalidation.

I was happy to say that PHIN will very soon launch a secure web-based system through which consultants will be able to view all of the data we have collected from hospitals, NHS hospital episode statistics, clinical registries and audits, Friends and Family Test, PROMs and elsewhere.

You will be able to understand what data is available currently about your practice and, I hope, work with your hospitals and professional associations to improve it until it is accurate and valuable.

I said that PHIN would be looking for volunteers to pilot and test the system with, and some of the plastic surgeons present immediately jumped in.

Matt James 4 webMoments later, everyone in the room had volunteered to take part. That more than made my day.

If 2015 carries on in the same vein of enthusiastic participation in the endeavour to improve the information we can make available, and in doing so make private healthcare work better for everybody, then we can all look forward to a good outcome.

Matt James (right) is chief executive of the Private Healthcare Information Network