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.


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]

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7 Responses

  1. Steve O' says:

    “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.

    • Pat says:

      Totalitarians are so predictable because the mass of morons who put them in power is always so predictable.

    • Seneca says:

      “…trotskyist hemp-fueled blather…”—Great line!

      I’m going to steal that one and it is great in this context

  2. Cliff Norman says:

    “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

  3. Sir Lance-a-lot says:

    “Doctors just don’t give a shit about this.”

    Yeah, but administrators do, and aren’t they the ones who really count here?

  4. RS says:

    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.

  5. Perry says:

    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.

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