Dr. Berwick and Quality

Here is an interview with the former head of the CMS, Dr. Don Berwick.   He  is the guru of quality. He seems like a nice man.  He is a great interviewee and is very intelligent. Much of what he says is right. Unfortunately, some or all of that  is only good in theory. Quality is a great example. We all want better care. We all want less infections. We all want our patients to have better “numbers” on their blood tests, blood pressure, etc. In reality, though, pay-for-performance programs, which measure and pay doctors on how their patients numbers are, are failing miserably. The BMJ study looked at the British NHS and found with hypertension it was a disaster with no changes in patient outcomes and cost a ton of money. The recent Medicare pilot programs are failing also and many are going belly up because of the cost. There is no real evidence that these P4P programs ever worked. The analogy would be paying cops more if there are less and less drunk drivers. They aren’t the ones drinking! In that scenario, cops may not want to catch these drivers because they would be paid less. Relating that to medicine, doctors will fire patients who can’t get their numbers under control so they look better and get paid more. It is happening already.

The trickle down effect of our friend Don Berwick, who hasn’t seen a patient in years, is that hospitals are getting rid of healthcare workers and hiring more and more administrators to oversee all the mandates and quality metrics of the affordable healthcare act. All this NOT mentioned by the interviewers. They mock FOX but MSNBC is just as bad.

By the way, Dr. Berwick, the quality “movement” worked on cars but people are not cars.  Sorry to let you in on that little secret!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “Dr. Berwick and Quality

  1. Susan Ortiz
    December 19, 2011 at 1:20 pm

    Finally, one of us has stepped forward to confirm that indeed, the emperor has no clothes. So many docs are so busy being “providers” that they cannot see what is being lost day by day. You are accelerating the “wake-up” point and may just be the catalyst to doctors seeing through the veil that keeps them moving into this madness. May you be guided to continue this important work, inspire other doctors to find the courage to listen to their higher wiser self, and to take action to restore the dignity and sacredness of the doctor/healer-patient relationship.

    Susan Ortiz MD

    • Doug Farrago
      December 19, 2011 at 1:24 pm

      Thanks for those incredible words!

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