Quality Metrics Mean Nothing…Again
A new study in Health Affairs found that:
A sizable bonus or sharp pay cut riding on the quality of patient care did little to change doctors’ performance in a study.
This, once again, proves metrics mean nothing. Look how well that has done in education? Teachers are going to jail in Atlanta for cheating on exams. Doctors will follow in the same path if we let this crap continue.
But doctors are different, right?
Kaiser Health News reports that “there are few winners” in the first year of the government’s new quality incentive for physicians, which links Medicare payments to how well they score on quality measures and how much their patients cost the program. Of the 1,010 large physician groups “that the government evaluated, just 14 are getting payment increases this year, according to Medicare.” On the other hand, only 11 groups face reductions for low quality or high spending.
My conclusion? Doctors just don’t give a shit about this. And because of that indifference, moving to quality metrics to pay doctors is a massive mistake. I have been saying this for a decade.
“Quality will be decided by the Workers’ Soviet. Any persons with further questions will line up behind the barn.”
Sheesh – why are totalitarians so predictable? The yabble that comes out of the smart set sounds as foggy and predictable as any 60’s Trotskyist hemp-fueled blather to come of of West Berkeley.
“Automate practices and leverage cost-effective integrated client-centered software and evidence-grounded service platforms. Offer high-margin consumer-centric services for patients in a hybrid consumer model.” These noises are what spontaneously emerges from the minds of our quality referees and overseers. Yay.
Totalitarians are so predictable because the mass of morons who put them in power is always so predictable.
“…trotskyist hemp-fueled blather…”—Great line!
I’m going to steal that one and it is great in this context
“When a measure becomes a target, it ceases to be a good measure.” Charles Goodhart (1975)[i]
Read more about a disaster in the UK: http://scienceofimprovement.blogspot.com/
Cliff Norman
“Doctors just don’t give a shit about this.”
Yeah, but administrators do, and aren’t they the ones who really count here?
A little off topic, but great – check out the Newsweek article this week ripping the ABIM a new one:
“It is just shocking,’’ Charles P. Kroll, a certified public accountant who specializes in health care, says of the consolidated financial statements of ABIM and a related entity, the American Board of Internal Medicine Foundation. “I have never seen anything like it in my 35 years of accounting and auditing experience.”
The treasurer of the ABIM Foundation is Dr. “Joy in Practice (Tm), AMA VP of Physician Satisfaction” Sinsky.
Yeah well here’s the scary part. With the pending SGR fix, in the next 5 years all payment will be based on so-called “quality”. Which is to say, rationing testing and studies according to government protocols, and these idiotic quality measures.
Yipee.