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Magazine rates state medical groups

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JANESVILLE — Dean Clinic tied for third place in a recent Consumer Reports rating of 19 large Wisconsin medical groups, while Mercy Health System tied for third from the bottom.

All of the 19 providers, which combine to serve nearly half of the state's patients, scored above the national average in the report, which was included in a special version of the magazine's February edition in Wisconsin.

The report backs the state's federal ranking last year, when Wisconsin was second only to Minnesota in overall health care quality.

Compared to national benchmarks, all of the 19 health systems perform "very well" in the Consumer Reports rating, said Chris Queram, president and chief executive officer of Wisconsin Collaborative for Healthcare Quality.

The magazine collaborated with the Robert Wood Johnson Foundation and the Wisconsin Collaborative for Healthcare Quality, with whom the medical groups have voluntarily shared their performance data.

The ratings, using 2011 data, include one overall score and seven measures based on data the groups collect on how well they provide essential care, such as screening for certain cancers and vaccinating against pneumonia, and how well they treat people who have heart disease.

Queram cautioned that the Consumer Reports ratings used only seven of the 32 measures the state collaborative reports. It would be inappropriate to say conclusively how any one provider performs by only looking at a segment of the data, he said.

"(It's a) great starting point for a consumer/patient to ask questions of his or her physician to make sure they're getting the right care for their particular condition and to feel comfortable knowing this is an organization that has made a commitment to put information out there, regardless of how it may look, to continuously improve services," he said.

The ratings, including the measures not included in the Consumer Reports findings, are available online at wchq.org.

Dean Clinic

The magazine used its four-circle performance rating system, with 4 being the highest score. Dean received 4s for its cervical cancer and colorectal cancer screenings, adult pneumonia vaccinations and LDL cholesterol screening and control in patients with vascular disease.

"To be toward the top of the very best is something we're very proud of," said Dr. Mark Kaufman, chief medical officer for Dean. "We all recognize we still have opportunities for improvement, and, quite honestly, we continue to work on those."

Dean Clinic has 118 primary-care physicians primarily in Dane and Rock counties.

Being toward the top of the rankings for screening and blood pressure control is even more significant "because you're actually controlling a disease that, if you do well, will reduce cardiac morbidity and mortality," Kaufman said.

Over the last few years, corporate goals have been set focused on quality of care based on the collaborative's metrics.

"Corporate goals cascade down to everybody in the organization," he said.

Primary care physicians receive monthly reports on individual performance based on the goals and are scored on a red, yellow and green scale, he said. Physicians within the same office can also see their colleagues' monthly performance results.

As part of the goals and monthly reporting, Dean has created a support structure of nurses for primary care teams. Patients often don't make appointments for screenings that doctors know patients should have.

Using electronic medical records, nurses are able to quickly find every patient due for a colonoscopy or who has high blood pressure and reach out to them, he said. Nurses call those patients and offer to schedule an appointment, answer questions or refill medications. Teams will begin this year focusing on patients who should get a mammogram, he said.

"That's been a huge part of the success story at Dean," he said.

Another piece that has helped is aligning physician compensation with quality goals, he said.

Mercy Health System

Mercy received 3s on six of the seven screening scores and a 2 in osteoporosis screening.

"We're really, really proud of our results actually," said Dr. Keith Konkol, associate medical director for Mercy. "There's always room for improvement. You have to look at the background. Wisconsin is an extremely competitive state for health care."

Mercy Health System has 163 primary-care physicians in four counties across southern Wisconsin and northern Illinois.

Mercy leaders said they are proud they took the voluntary action to join the collaborative group to compare their system to others and be transparent about their data—even exposing themselves a little in a competitive state.

"Even though we'll be the first to admit there's room to improve, the data are really just one point in time," Konkol said.

One of the benefits of the reporting is identifying areas to improve, such as osteoporosis and breast cancer screenings, Vice President Barb Bortner said.

Mercy's preventive measures are improving, primarily because it has an electronic medical records system, which has helped to capture data to improve quality of care, she said.

When Konkol logs into the records system at the start of an appointment, he sees all the preventive measures needed for the patient.

"It makes a tremendous difference," he said, compared to tracking that data through paper records.

Mercy has now implemented the electronic medical records system across the whole system and now is enhancing the records to use them to the fullest extent possible, Vice President Ruth Yarbrough said.

Mercy also is using the system to document reasons people decline preventive services so it can address those issues, she said.

Mercy works hard to provide many free screenings at community events, and it is working to get those results into patients' health records, Bortner said.

Patients should use the ratings as a starting point to ask their providers more questions, Yarbrough said.

"We want them to know Mercy is always striving to be better to provide the best care possible," she said.