X-Raying the Practice: Data Drive Higher Quality Outcomes

“The new payer paradigm – the need to deliver higher quality at lower costs to get paid by Medicare – means there’s a real need to change. Everybody’s trying to figure out, ‘how do we do this?'," says Dr. Edward Cohen.

For Dr. Cohen, the answer was clear. “To improve quality, you need to pick a metric, measure it, and figure out how to change," he points out. He needed to use data to see inside his practice, especially since it has grown so successfully.

“Across the country, urologists have been forming larger groups,” Dr. Cohen explains. “It gives you more control of patient care, which patients really want. Five years ago, we brought nine separate practices together and I became CEO of Genesis Healthcare Partners. Today, we have 28 doctors, 200 employees, a pathology lab, a radiation group, an imaging center, and an advanced prostate cancer and research division. We even added a gastroenterologist group.”

But Dr. Cohen wanted to know if owning so many service companies would tempt doctors to order more tests and procedures than are needed. “I wanted us to be totally above board, so I named Dr. Franklin D. Gaylis to be our quality director. He tracked our metrics for every single doctor in our practice, and a year later the data showed we had been practicing appropriately," he explains.

Having those analytical skills was immediately useful. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA)-based screening for prostate cancer. “We respected the recommendation, but we couldn’t ignore the fact that medicine had decreased death by prostate cancer by 25 percent. For us, the real question wasn’t whether to use the test or not, but how could we better utilize it?

“That question led us to partner with Chris Kane at the University of California, San Diego School of Medicine to develop an Active Surveillance Protocol for prostate cancer. Rather than treating patients on day one, we use data to track their progress and see how we can improve outcomes within that group. We started sharing the data on how each doctor was performing: Here is where you are; here is where our group is; and here is where we are compared with the rest of the doctors across the country. Over time, doctors came to really value the feedback and it drove real improvements. We were excited, so we said ‘what’s next?'," Dr. Cohen says.

“We decided to reduce infections in prostate biopsies. We created ‘time out’ policies that ensure that before a biopsy is done, doctors can make sure they have the right patient, the right preparation, the right antibiotics. It’s another quality parameter we can measure, report on, and use to drive positive change," he states. "You have to measure what each doctor is doing over time. We don’t really know how we’re really performing unless we measure over time. That’s the whole goal of quality: get the data and see what’s really happening," Dr. Cohen emphasizes.

“We recently hired a graduate student who found a smart way to extract data from data tables from our EMR records to get more insight. For example, the drug Provenge can extend the lives of patients with castration-resistant prostate cancer, but it can only be used in a narrow time frame. Now, if we see that a patient’s PSA doubling time is less than nine months, we can automatically alert our doctors that the patient might be ready for a bone scan to determine if Provenge should be prescribed. That would be impossible to do without our data.”

Dr. Cohen’s dedication to quality is matched only by his dedication to his family. He is devoted to his wife and his four sons, aged 19 to 26. On the weekends, you might find him skiing, playing golf, or taking long walks on the beach with his wife; or maybe on an airplane to New York, San Francisco, Seattle, or Colorado to visit one of his sons.

Dr. Cohen is proud of the progress Genesis has made. “It’s very exciting leading the group, and I still do clinical work. My goal is to continue to protect the independent practice of medicine," he says. "The entrepreneurial spirit of independent doctors, their sense that 'I can make good things happen' is what provides some of the best healthcare in the country.”