12/17/2013    James J DiResta,DPM, MPH

Performance Measures for Podiatrists (Charles H. Allison, DPM)

Dr. Allison brings up a very important problem
that most of us are either experiencing or will be
experiencing soon enough with regard to
quantifiable performance measures
for podiatrists.

First, as a specialist physician, you are
not alone, many specialists have a tough time
providing meaningful performance measures that
are exclusive to themselves or their specialty or
done frequently enough to be of any statistical
significance relative to performance and bonus
compensation. However, there are areas that you
strongly participate in both directly and
indirectly that can prove your value and you need
to bring those measures forward and you ought to
be aggressive in proving your own worth in the
overall performance of the group as a whole.

There are several measures you can directly point
to such as your high % use of generic vs brand
named drugs, your high % use of eRxing, your
relatively low use of high cost imaging
studies relative to other similar specialists,
your appropriate use and timing of prophylactic
antibiotics, your strong participation in getting
both process and outcome measures done for those
with chronic diseases such as diabetes and
hypertension.

Just because the HbA1C "value" is tracked to the
internist or the endocrinologist, as a podiatrist
your constantly reminding at each visit to your
diabetic patients as to the importance of their
diabetes control and "ABCs" (HbA1C, blood pressure
and cholesterol) and constantly asking and
educating about their control plays a very large
role in those outcome measures falling into
"normal" ranges and to this at risk population
going and getting tested (i.e. process measures)
and the group having high performance on those
measures; taking routine BPs on your patients
especially those with known hypertension to
document control does the same thing and is
retrievable.

If the clinic and/or hospital have the
capabilities of looking at their analytics
relative these measures and to the overall
"episodes of care" that can be also be tracked
to you directly and then you can show how well you
perform in treating a paronychia or plantar
fasciitis with your low use of oral antibiotics
and ancillary testing with regard to paronychias
and your direct treatment for heel
pain with little use of expensive testing and
little need for outside referrals for the
conditions you commonly treat keeping cost in the
network, keeping the quality high and the overall
expenditures low.

On the other hand, if you find yourself as an
outlier where say you prescribe oral antibiotics
and worse still expensive antibiotics on
every paronychia or you order scans and MRI's on
every heel pain case then you have to take a good
look at your practice patterns or in time you will
be asked to leave that group or no longer be
contracted with a particular third-party payer or
with an ACO agreement, etc.

You can also use certain times of the year for
your own specialty with appropriate screenings and
promote them to your practice of podiatry like use
of diabetes awareness month and say in the month
of May which is "skin cancer screening month" and
your correspondingly doing your own promotional
screenings for skin cancers of the foot and
use of educational materials available to your
clinic patients during that month etc. You
literally need to take a look at your daily work
from outside the box and work the practice
measures you already have embedded in place and
you need to tease them out and also look for
measures you ought to have in place to establish
the perception of value and "best practices" for
your specialty.

We know our value in providing annual CDFE but the
measure is hard to track in present coding but
this is where the profession is working to get
more direct measures that only we as DPMs can
perform fully. It has been my experience that our
performance scores are as high as, if not higher
than other specialists in orthopedics, dermatology
and others when it comes to bonus compensation.

James J DiResta,DPM, MPH, Newburyport, MA,
James.J.DiResta.DMS04@Alum.Dartmouth.ORG

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