General Internists in Pursuit of Diagnostic Excellence in Primary Care: a #ProudtobeGIM Thread That Unites Us All

Kwan, Janice; Singh, Hardeep

doi:10.1007/s11606-018-4343-8

Cited by 5 publications

(2 citation statements)

References 9 publications

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“…39 Perhaps of greater immediate applicability would be the expectation that delivery organizations such as ACOs, practices participating in primary care reform through the Comprehensive Primary Care Plus demonstration, and oncology practices in the Oncology Care Model (discussed below) would conduct quality improvement activities related to accurate diagnosis. 40 They could develop specific accountability measures for themselves, in a process overseen by CMS.…”

Section: Alternative Payment Models Designed To Improve Diagnosismentioning

confidence: 99%

Payment Innovations To Improve Diagnostic Accuracy And Reduce Diagnostic Error

Berenson

Singh

2018

Health Affairs

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Diagnostic accuracy is essential for treatment decisions but is largely unaccounted for by payers, including in fee-for-service Medicare and proposed Alternative Payment Models (APMs). We discuss three payment-related approaches to reducing diagnostic error. First, coding changes in the Medicare Physician Fee Schedule could facilitate the more effective use of teamwork and information technology in the diagnostic process and better support the cognitive work and time commitment that physicians make in the quest for diagnostic accuracy, especially in difficult or uncertain cases. Second, new APMs could be developed to focus on improving diagnostic accuracy in challenging cases and make available support resources for diagnosis, including condition-specific centers of diagnostic expertise or general diagnostic centers of excellence that provide second (or even third) opinions. Performing quality improvement activities that promote safer diagnosis should be a part of the accountability of APM recipients. Third, the accuracy of diagnoses that trigger APM payments and establish payment amounts should be confirmed by APM recipients. Implementation of these multipronged approaches can make current payment models more accountable for addressing diagnostic error and position diagnostic performance as a critical component of quality-based payment. E Rationale For Addressing Diagnostic Accuracy In Payment ReformThe prevailing payment system that is based on fee-for-service fully tolerates and, to some unfortunate extent, even encourages diagnostic error.

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Section: Alternative Payment Models Designed To Improve Diagnosismentioning

confidence: 99%

Payment Innovations To Improve Diagnostic Accuracy And Reduce Diagnostic Error

Berenson

Singh

2018

Health Affairs

Self Cite

View full text Add to dashboard Cite

show abstract

“…W e thank Wallace and Matthias for their response to our call for diagnostic excellence in primary care. 1 In their letter, they point to limitations of likelihood ratios of symptoms and signs, giving the example of Bcough, fever and auscultation^as being Binsensitive and nonspecific for the diagnosis of pneumonia^. However, we believe this view downplays the relationship between inadequate data acquisition via history/exam and diagnostic error.…”

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confidence: 99%