four additional medication classes, including antidepressants and antihypertensives.
The care protocols also improved physicians’ appropriate
use of lumbar spine MRIs from 37.4% to 79.8%. The spine
MRIs were part of a complicated lower-back-pain protocol,
and the guidelines educated physicians on when it was
appropriate to use imaging. This is an issue because unnecessary imaging can lead to surgery that is unlikely to solve a
patient’s pain in the long run and that puts the patient at risk
for infection and readmission, episodes the system would
have to absorb financially. Couch says deploying a strategy
that reduces utilization in a FFS environment seems “
financially disadvantageous,” but he says the system is preparing
for the future of value-based reimbursement.
“Value attracts the market,” says Couch.
The quality benchmarks are not just for the BSWQA.
Couch says its commercial payer contracts include anywhere
from six to eight quality measures that must be met for
22 HealthLeaders n March 2015
the BSWQA board of managers. The board has approved
more than 100 evidence-based care protocols. So far, these
protocols have improved the generic prescribing rate among
physicians from 75.8% to 79.2%. While that is not a huge
uptick, Couch says increasing generic drug utilization is tied
to building a culture in which physicians work in a clinically
integrated way instead of favoring their own prescription
patterns, which may be more expensive to the patient and
“Honestly, how we’re paid is a strong driver,” says Couch.
“The financial reality is doctors and hospitals and others
in the healthcare sector behave according to their own self-
interests. Until everybody is pulling on the same rope of high
quality, cost effectiveness, and clinical integration—which is
transforming the healthcare system as we know it—you can’t
To improve the rate of generic prescribing further,
BSWQA will focus on having its physicians use generics for
>FLEXIBILITY. Amy Ho, MD, is a
24-year-old first-year resident at the
University of Chicago’s emergency
medicine residency program. She
says she considered other specialties but chose hers based on income
potential and because its shiftwork
nature allows a physician to work
more, if desired, or less, to allow pursuit of other interests.