Patients and providers lament the expensive, often substandard quality of healthcare delivered in the U.S. While the healthcare system at large remains troubled, some physician practices stand out from the rest as stellar examples of care providers, demonstrating a model of high-quality care and low costs.
In collaboration with Stanford University's Clinical Excellence Research Center, The Peterson Center on Healthcare — a new organization established by the Peter G. Peterson Foundation — researchers evaluated quality and healthcare spending at more than 15,000 practices with at least two clinicians providing primary care. The researchers' evaluations found that fewer than 5 percent of these practices ranked in both the top quartile for quality of care and in the lowest quartile for total healthcare spending (the study accounted for the severity of illness among physicians' patients).
However, analysis of 11 high-performing practices showed these practices shared 10 similar features. These 10 features are shown below.
1. Patients have a sense that the practice is "always on call," meaning they can always reach the care team promptly, whether the practice is open or closed.
2. Physicians abide by quality guidelines and administer tests and treatments appropriately. Care teams have developed systems to ensure patients always receive evidence-based care and physicians carefully consider the benefits, risks and patient preferences when ordering tests and treatments.
3. Practices actively solicit patient feedback, both good and bad, to improve their patients' experiences.
4. Practices avoid outsourcing tests and procedures when possible. Care teams do as many tests and procedures as possible within the walls of the practice when they can be done safely, often under the guidance of specialists.
5. Physicians maintain close communication with their patients, even after a referral. Physicians refer to a select group of specialists they trust will best serve their patients' interests and stay in close communication during the care process.
6. Practices are active with follow-ups. They ensure patients are seen promptly following hospitalizations, adhere to medication regimens and see specialists when appropriate.
7. Practices maximize support from staff. Staff are encouraged to perform at the "top of their license" to provide the best support to physicians.
8. Employees work in open workstations. Open environments facilitate physician supervision and communication across clinical teams.
9. Compensation is balanced so that physicians are paid based on the value of the care they provide and not solely on the basis of their productivity.
10. Investment in staff is prioritized more than space, equipment and technology. By saving money on these things, providers don't need to see more patients or order expensive tests to increase revenue. They rent modest offices and only invest in the lab, imaging or other equipment necessary for cost-effective in-house treatment.
"Our findings challenge the belief that excellent primary care can only be provided by large healthcare organizations that are household names," said Arnold Milstein, MD, director of Stanford's Clinical Excellence Research Center. "We found un-sung physicians who are achieving something extraordinary – much better quality at lower cost. What's most encouraging is that their distinguishing features are tangible, and transferable on a national scale."