Checking private doctors’ quality
Within a few months, every specialist working in private practice should have been asked to check data about their work before it is published to the public. Matt James appeals for doctors to engage with the process.
A transformational year lies ahead for private healthcare. We have already seen a tranche of changes in how the sector operates following the Competition and Markets Authority’s (CMA) Private Healthcare Investigation Order 2014.
Consultants working in private practice are acutely aware of the new rules around accepting private hospital incentives, which have placed additional pressure on their practice.
Now there are more changes they need to be aware of and engaged in.
As the ‘information organisation’ appointed by the CMA, we at the Private Healthcare Information Network (PHIN) have a legal mandate to collect and publish quality and safety information at both hospital site and consultant level by April 2017.
Aggregated information on performance measures, including:
The number of procedures;
Patient satisfaction;
Adverse events;
will be publically available to help patients make decisions when choosing a consultant and facility for their treatment.
We know many consultants and hospitals are feeling the pressure brought about by these changes. But while the changes brought about by the CMA order are significant, they are also necessary.
Patient-focused information has taken the centre stage in healthcare in recent years. The evolution of websites such as NHS Choices mean that patients are no longer simply receivers of care.
They are informed customers with the right to choose the care and provider that’s right for them.
Equally, while Care Quality Commission (CQC) inspections have had some teething problems, using quality information to improve standards and accountability is a welcome step.
Fallen behind
Unfortunately, privately funded care has somewhat fallen behind the NHS in this regard. For private healthcare to show its quality and empower patients, there has to be accurate, robust and transparent information in the public domain.
It is simply wrong that people have access to less information about quality and safety on health services they pay for than they receive on the NHS. This is a real opportunity for consultants and hospitals to demonstrate to patients the quality of their services.
To achieve this, PHIN needs to develop new systems and processes for collecting sensitive data on more than one million episodes of care.
Over the last year, we have made significant progress with the help of our hospital members, currently representing over 80% of the private healthcare market, who have already started submitting data to help us shape and refine this complicated process.
For the next year, our focus will switch to roll-out with all hospital sites and consultants, ensuring data is collected and validated securely and safely, while making the process as straightforward as possible.
Practically, this year, we will focus on two key priorities with consultants.
1 Firstly, we will continue our engagement with the profession through the Federation of Independent Practitioner Organisations (FIPO). FIPO has convened a Clinical Outcomes Advisory Group (FIPO-COAG), which includes representation from the Federation of Specialist Surgical Associations and other specialty organisations.
Our work with FIPO fits into three broad areas:
1. Information from clinical registries and audits
Clinical registries have an essential role in improving patient care and are a valuable source of information. We are mandated by the CMA to engage with clinical registries and include relevant information in what we publish.
However, we are mindful that registries need to have reached a sufficient size and maturity for their information to add real value to patient understanding.
Since we have access to data on all episodes of private care, we may be able to help registries to understand the extent to which hospitals and consultants are actively engaged and, in due course, to help measure ‘compliance’.
Over the next six months, we will be engaging with the leading registries, with the help of FIPO-COAG, to understand what information they have that is sufficiently comprehensive and mature to republish in a way that is appropriate and accessible.
FIPO-COAG provides an essential consultant view to ensure that the information we republish adds value to public understanding and is a fair reflection of performance.
2. PROMS and other standard performance measures
The publication of patient-reported outcome measures (PROMS) and other performance-specific measures is also explicitly covered by the CMA Order. While most will be familiar with the four
PROMS used in the NHS, we will be encouraging hospitals to use up to 11 measures at each hospital site.
This is a significant change for private healthcare, but all of the instruments chosen are well-established in their fields.
Specialty association members have already reviewed each of the 11 measures, but where questions or concerns remain, we can still work through them.
For adverse events, similarly, we are taking known and established measures to keep things simple. These include clinical indictors and infection control surveillance measures as submitted to the CQC, and ‘never events’ as defined by NHS England, which are familiar to the majority of hospitals.
3. Episode-level admissions data
Episode-level admissions data is crucial for providing a meaningful context for many of the performance measures, as well as providing some of the measures directly and enabling risk adjustment.
We recognise concerns within the private healthcare sector that publishing measures such as mortalities and infection rates in isolation is misleading. These concerns may well be justified, as there are a multitude of factors which contribute clinical outcomes, not least the complexity of each case.
Collecting admissions data will allow us to develop a process to adjust case-mix at a more nuanced level and on a wider range of procedures than ever before.
Taking a collaborative and involved approach to our professional engagement is a must if we are to fulfil both the letter and the spirit of our mandate. FIPO-COAG is an active and constructive clinical voice, shaping our thinking and adding authority to this process.
2 Our other priority area in 2016 is get all the thousands of consultants in private practice directly involved, ensuring they have the opportunity to see and check the data.
While some specialties have seen consultant-level outcomes publication through registries and audits over the last couple of years, it is fair to say that the CMA’s Order requires us to go further and across a broader range of specialties.
The CMA’s Order actually places no direct obligations onto consultants in terms of producing outcomes measures. The duty to ensure that consultant-level performance measures are published falls on hospitals and PHIN.
But it would clearly be wrong to cut consultants out of a process of producing data that is about them and potentially material to their livelihood.
So PHIN has, through consultation with our members and stakeholders, interpreted this role so that all consultants will be asked to check their data and approve it for publication before we publish it.
Your help needed
This should be an exercise in communicating the quality and value of private practice, and we want to ensure that every consultant’s work is accurately reflected. For that, we need your engagement.
We understand there are a huge number of calls on your time and that you would probably rather be seeing patients than checking data. As such, we are keen to make the process as intuitive and simple as possible for everybody.
Since January this year, private hospitals, including independent hospitals and NHS private patient units, have been collecting and coding data on privately-funded episodes of care.
By September, all providers should be submitting their data to PHIN to be processed and made available for checking in time for publication in April 2017.
By the autumn, we will be contacting every consultant working in private practice to ask them to log into our secure online portal and check their data. Prior to the full roll-out, we are running a
Spring pilot study with around 200 consultants chosen from across our founding hospital members.
This will provide an opportunity to rigorously test the data we receive from hospitals, and processes for ensuring data is corrected, in a timely and responsive way.
If you have been asked to participate by your hospital group, it will contact you individually. We are grateful for your input.
Although the next 15 months will bring many challenges, we believe this will deliver private healthcare to a much better place.
Showcasing quality
Ultimately, this is about showcasing quality and providing patients with the service they deserve in terms of choice and accountability.
To do that, the information must be comparable to that used in the NHS. This will require a collective effort from PHIN, hospitals and consultants as we implement change.
But as we enter a ‘business as usual’ state from 2017, I believe we will start to see real and tangible benefits.
I am excited for the year ahead and confident in what we will achieve. For those not involved in our pilot or through the specialist associations and FIPO, there are no imminent actions.
But there will be practical changes in data-flows and collection as hospitals endeavour to comply with their new legal requirements.
As we look forward to the autumn, I hope all consultants will take the opportunity to engage with us. After all, only the consultants that engage with us can ensure the data which is published on their practice is right.
At the start of 2016, the CMA approved PHIN’s Strategic Plan 2015-2020, setting out its objectives, governance and plans. This can be downloaded from the PHIN website
Matt James (right) is chief executive of the Private healthcare Information Network (PHIN)