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!