SAN MATEO, Calif.--(BUSINESS WIRE)--Nationally over 230,000 primary care physicians (PCPs) and specialists are evaluated based on achieving acceptable clinical protocol ranges in treating medical conditions (or Clinical MedMarker Protocol Ranges™).
“MedMarkers™ are process of care quality measures that are the key services associated with cost-of-care in treating a medical condition. For example MRI of spine is the main MedMarker™ (or correlated service) in treating low back pain. The acceptable Clinical MedMarker Protocol Range™ for routine low back pain is no more than 0-to-20 out of every 100 episodes with an MRI of spine,” asserted Dr. Douglas G. Cave, President of Cave Consulting Group (“CCGroup”).
He continued, “Clinicians want to understand the services they need to focus on to reduce unwarranted practice variations. The medical condition-specific MedMarkers™ answer this question. Also, clinicians want to know the appropriate level of utilization that does not represent potential under- or over-utilization of services. Clinical MedMarker Protocol Ranges™ address this latter question.”
Medical conditions with significant MedMarker™ practice variations include low back pain, degenerative joint disease, headaches, ischemic heart disease, cataracts, hernias, and calculus of kidney. “These are the conditions where health systems should focus on quantitative clinical pathway development,” stated Dr. Cave.
A common question posed by clinical leaders is where to start on pathway development efforts for degenerative joint disease and the associated MedMarker™, knee replacement. Dr. Cave affirmed, “In working with health systems, CCGroup applies the Cave Grouper™ software that groups ICD.10 diagnosis codes into 542 meaningful medical condition episodes of care; one of these conditions is degenerative joint disease. Then, we look back in time to observe what services were delivered to patients six months to a year (180 to 365 days) before their knee replacement. This is the time period where the patient still has diagnostic and therapeutic processes underway to treat degenerative joint disease before knee replacement.”
“Some of the most common services include corticosteroid injections into the bursa for pain relief, knee arthroscopy, knee X-ray, MRI of joint lower extremities, chiropractic manipulation, therapeutic exercises, ultrasound therapy, and hyaluronan injections, such as Synvisc,” defined Dr. Cave.
Many of these services appear appropriate, while some services probably are not efficacious in delaying or preventing the need for a knee replacement. For example, 45% of patients had a knee X-ray, while less than 5% had an MRI of joint lower extremities. “Based on these findings, a clinical pathway may define that most patients should receive a knee X-ray, and not an MRI of lower joint extremities, to define and evaluate the extent of the degenerative joint disease,” stated Dr. Cave.
“Other findings showed that less than 3% of patients had a knee arthroscopy, and just 10% had hyaluronan injections. The question arises as to the efficacy of these services; not many patients had these treatments. On the other hand, over 50% of patients had corticosteroid injections into the bursa for pain management. Surprisingly, six months to a year before their knee replacement, less than 10% of patients had any physical therapeutic exercises to strengthen the knee, and possibly prevent the need for a knee replacement. One pathway to consider may be corticosteroid injections for pain management, followed by an intensive course of physical therapy,” stated Dr. Cave.
About Cave Consulting Group, Inc. (CCGroup)
Cave Consulting Group, Inc. is a software and consulting firm located in San Mateo, California. The company is focused on improving the efficiency (cost-of-care) and effectiveness (quality-of-care) of the healthcare delivery system. Senior management of CCGroup has assessed the performance of physicians and hospitals for over 26 years for health plans, HMOs, physician groups, health systems, TPAs, and employers.