How putting physicians in charge can drive revenue, care quality

Smita Rouillard, MD, associate medical director of Oakland, Calif.-based The Permanente Medical Group, joined Becker's to discuss ways that physicians leverage their power in her health system. 

Editor's note: This response was edited lightly for brevity and clarity.

Question: How can physicians leverage their power in the healthcare industry?

Dr. Smita Rouillard: As part of a physician-led, integrated and value-based organization, the Permanente Medical Groups have always operated differently. Our model demonstrates how physicians can partner with hospitals and health plans to deliver 21st century medicine. We believe physician leadership drives exceptional care for our patients. Physician leadership guides every action, and every decision is made with the patients' best interests at heart.

We know, through our nearly 80-year history at Kaiser Permanente, that value-based care drives better quality. We see that in our NCQA results; we see that in our CMS results. Better quality equals better cost outcomes. Physician leadership enables us to derive this through quality efforts versus costs alone. For example, as a gastroenterologist, I thought it was interesting to see how a large fee-for-service organization approaches colonoscopy surveillance and diagnostic care. This now requires pre-authorization while a screening colonoscopy does not. Why? To prompt physicians to use guidelines in decision-making.

We operate differently with guidelines at the front of physician decision-making and due to our prepaid model, the patient, physician and health plan interests are all in alignment. As a first-line test for screening the average-risk individuals, we want to use fecal immunochemical tests, which patients can use at home and then send to a lab for analysis. Depending on the outcome of those tests, a physician may order a colonoscopy with no pre-authorization and no out-of-pocket co-payment for the patient. We use gastroenterology society guidelines (for example, those provided by ACG, AGA, ASGE, etc.) to determine the interval for colonoscopy surveillance — without the need for pre-authorization. It is a perfect example of the difference of true integration and physician leadership with patients at the center of the decision-making, not in the middle.

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