Fifty Percent
I am biased. I have repeatedly pointed out that the “quality” fad is a sham and unproven. I have offered up study after study to this blog (and my former employer in Maine) showing that there is no proof that quality initiatives improve patient care or even lower the cost of healthcare. I admit my bias because I am sure there may be a study or two that supports these initiatives and I may had a blind eye to it. If I did then I am sorry. Even so, there are NOT enough studies, in my opinion, that counteract the negative ones against this trend. That being said, a shared-savings agreement between Hawaii Medical Service Assn. and Hawaii Pacific Health puts 50% the hospital’s annual pay increases over the five-year contract term dependent on achieving both quality improvement and cost savings thresholds. WTF? Fifty-percent!!!!! Hawaii Pacific employs 350 physicians. Watch that number dwindle over the next few years. You can read the article here but don’t think you will find great reasons for this move other than typical administalian doublespeak as listed in quotes from people interviewed in the piece. Don’t laugh too hard when you read them:
- The whole health care system and country will need to find a way out of this problem we’re in.
- We think we have a good solution
- The pressures are there to get involved in these.
- Adoption “is going to turn on what the experiences are with these original ones”.
- It’s a step on the road toward a full ACO, although I’m not sure what a full ACO is anymore. It’s been defined so many ways.
- There is no contingency plan, except to go back to the way we were, and no one wants to do that.
- Support for the physician-patient relationship is the key to making the health care system work. Our goal is to do everything we can to support that relationship.
Hawaii is definitely in front with their healthcare initiatives. Remember this from 2008?
I wonder if a psychiatrist who has a patient go nuts and, I don’t know, shoots up a movie theater, would get lower pay for not meeting “quality” markers for psych patients. Since the doc is now held to be at fault for a patient’s misbehavior, I’ll bet “Quality” pressures will encourage the shrinks to focus more on the neurotic housewife population, leaving the real crazies less access to care.
All this cost-saving debate is truly needed but just spins us in a circle. We as physicians can make sure we use sterile technique to prevent infections, we can track A1c’s to bring diabetes under control, we can urge patients to take their meds but NO ONE is accounting for the unspoken variable-the patients. I know in my Internal Medicine practice I stress preventive care, I constantly review with patients how to use the infuriating meter-dose inhalers (can’t anyone use these things correctly?) and I always review medications with the patients, but I can’t make the patient DO anything they are not interested in doing. If we could truly manage the patient outside the office and FORCE them to take their meds, call with small problems not huge ones, and eat properly I am convinced we could save the entire system at least 50% of the total cost of health care!!! What idiot invented the Super Size meal? If it’s there, must we eat it? How about a little discipline and responsibility?
The “quality” initiative has, of course, NOTHING to do with quality medical care. It is just the latest scheme to reduce payments to physicians. It is difficult for insurers to define good care, and they know that their across the board fee schedules do not give incentive to provide good medical care. By selecting arbitrary tests and treatments that can be “measured,” they have a system to set targets and limit payments if such targets are not met. It’s not the first such scheme, and it won’t be the last. Just try to document well when you order the tests and provide the good medical care that satisfies YOUR standards, and your patients and you will be fine.
When was it decided that the goal of physicians is to keep patients “happy?” Happy and healthy are no synonyms. I physician who is respected is much better than one who is liked. If only administrators pay was decided by surveys of their physicians…
I totally agree with you abut “quality” being a sham. All “quality” initiatives do is give Medicare an excuse to cut your payments because you don’t score well on their subjective quality scale. For hospitals, quality initiatives increase costs because we have to hire more nurses and take them away from patient care so they can review charts and report to mulitple agencies regarding the “quality” of care provided.
“Quality” is not about improving patient care; it is about being able to answer the questions correctly so you don’t lose reimbursement.