Outcomes Fall Flat
The evidence keeps pouring in that the great “Quality Movement” is failing. A new study shows that the hospital report cards on quality did NOT improve patient outcomes. As reported in Health Affairs and explained here in the American Medical News:
Seven years after the federal government started publicly reporting hospitals’ performance on quality measures, evidence suggests that this transparency effort has not improved patient outcomes measurably.
The word on the street is to “temper our expectations”. How is that for an understatement? What about the cost for this mess? I have been screaming from the rafters for years now but no one wants to listen. Quality measures, though sound nice and should intuitively work, are an absolute failure. People cannot be treated as numbers. Nature has a way of proving us wrong every time. Has no one seen Jurassic Park? It was written by a physician, you know.
Who cares what the public says. They have no concept of healthcare quality or performance.
Who cares what the Federal Government says ….. only physicians who accept Medicare patients
or public aid patients, no one else (i.e. Plastic Surgeons ) needs to care.
The Feds will “encourage you ” to “participate ” in “Meaningful Use” and other programs.
If you do in the next 3 years you get a “BONUS” from CMS . Wow !
Beyond 3 yrs if you forgot to care you get a beating with progressively lower reimbursement for seeing CMS patients.
NO BIG DEAL you say. I’ll quit seeing them, I live in a big city where I don’t need to admit patients to the hospital and can have a concierge cash only practice.
Just wait.
The rural docs among us, see 50% medicare, 20% Medicaid, 10% self pay and 20% insured patients.
The choice is either to move to a health care reform state with full employment or go to taking chickens in payment for appendectomy. ( That is 5 dozen eggs and 6 Fryers by the way).
Numbers won’t change outcomes if: the hospitals don’t care about bad press; the patients or referring doctors don’t know about the numbers ; the patients or doctors don’t have a choice, whether due to insurance coverage networks or geographical limitations.
“Quality” as a replacement for the doctor-patient relationship was inevitable once the government became the actual patient. We work to satisfy, placate, please, and treat government; the human beings who sit on the exam table are the raw material to be processed to accomplish that treatment.
This one, I have to take issue with. First of all, I will point out that you can pretty well find numbers to support whatever hypthesis you want.
Secondly–is it better not to use evidence-based medicine? To go back to the “it didn’t work, so we’ll do it more often” mentality? It’s like using antibiotics for a cold. If you do, they’ll get better in about a week and a half, if you don’t, they’ll stay sick for 10 days, right?
Thirdly, are we supposed to ignore medication errors, hospital acquired infections, wrong site surgeries? Maybe it doesn’t improve the outcomes you’re measuring–say length of stay, because the patients who die because of errors have a shorter length of stay than the survivors!
Sorry–hit my sore spot with that one!
We all should work on systems improvement. Quality measures that lead to pay-for-performance is bad for medicine. End of story.
Which also speaks to evidenced-based medicine, alas.