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The rule continues:
"Response: We believe that the final set of measures is appropriately focused and measures care furnished by a variety of providers including specialists, nurses, and nurse practitioners. We also believe the issue of including specialty providers who furnish primary care services is addressed in the two-step beneficiary assignment methodology discussed in section II.E of this final rule. We also agree that monitoring is necessary to ensure providers do not skimp on care or avoid at-risk beneficiaries."
5. Positive deviance or disruptive innovation. In healthcare settings, these two phrases, which have different origins and meanings, can be used to express the same idea. They implies a strategy in which providers look at peers—be they controversial individuals or entire institutions—that function differently, but still achieve excellent results.
One example of positive deviance comes from Michael Edmond, MD, chairman of infectious diseases at Virginia Commonwealth University, who eschews conventional wisdom that hospitals should perform active surveillance with testing to prevent hospital-acquired MRSA infections. Instead, he bucked that trend in favor of hand-washing and other universal precautions such as catheter insertion bundles. He got his infection rates down without using expensive testing and without having to put colonized patients into isolation.
Disruptive innovation is a similar idea. A concept originally proffered by Harvard professor Clayton Christensen, disruptive innovation can mean advancing healthcare quality through a wide range of new ideas: the use of payment incentives, transparency, retail clinics, comparative effectiveness research, and the use of social networks.
6. Essential benefits. In a bulletin released in December, the Obama administration has said that it wants state legislatures—not the federal government—to decide what will and what won't be required for coverage by health exchange programs, as long as benefits include some provisions in each of 10 categories specified under the Patient Protection and Affordable Care Act.
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