Costly and Not Useful

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I know this may surprise you but researchers have found that reporting quality metrics is costly and not useful.  Yeah, I know, who would have known?  A survey of 395 orthopedic, primary care, cardiology and multispecialty physician practices that are members of the Medical Group Management Association found:

  • U.S. physician practices in four common specialties spend, on average, 785 hours per physician each year on reporting quality measures.
  • Overall, that time costs practices an estimated $15.4 billion each year, according to a survey in Health Affairs.
  • 12.5 hours of physician and staff time per physician per week was spent on entering information into the medical record for the sole purpose of reporting for quality measures from external entities.
  • Even though physician practices are putting a lot of time and effort into reporting on quality metrics, most of them aren’t using the information to improve quality.

Halee Fischer-Wright, MD, president and CEO of MGMA, said a few things in a statement that sounded like Charlie Brown’s parents (Wa Wa Waa Wa) but included such phrases as:

  • top-down approach has failed
  • serves no purpose
  • it’s an exercise in futility
  • the federal government needs to get out of the business of dictating patient care through wasteful mandates

Great job, Halee!  Unfortunately, she has never said this stuff before:

  • This was Halee in May of 2015 when she was interviewed after she took over the lead at the MGMA, “There is also the question we ask all the time: Which one of you is the bad doctor? Meanwhile, if you actually take a look, someone has to be on that end. When I was a CMO, we worked toward changing the culture, but more importantly, what we looked into and ultimately delivered was actually a new model of care. At least it was innovative for Colorado — it was a patient-centered medical home.”
  • Or how about her testimonial for this company: “MCIS, Inc. integrating real-time analytics at the point of care is a game changer. It forces practices to think differently about using quality measures to improve Population Health Management. When analytics are applied immediately, care teams are able to provide better patient care during the visit.”
  • At the most recent annual MGMA conference she said, “The keynote speech I’m giving is ‘Stop Whining and Start Leading,’ ” Fischer-Wright says. “It’s about how physicians need to stop complaining. Effective cultures require strong leadership.”
  • Or when she said, ““The increased use of technology can improve the quality of patient care by improving records management, optimizing workflow and meeting HIPAA compliancy requirements.”

Clearly, Halee Fischer-Wright, MD was on the quality bandwagon until it no longer suited her.

The bottom line is that quality metrics have failed.  Let’s stop them immediately.  Let’s save that time and money to use to pay the staff or to reinvest into the practices.  Who really benefits from these metrics?  Well, the administrators, the hospitals, the MGMA, the insurers and the tech companies that crunch the numbers.  Do we really want that to continue?

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] 

  14 comments for “Costly and Not Useful

  1. March 10, 2016 at 11:28 am

    One group that benefits by quality metrics is the medical service consumer. The metrics really don’t have to be that complicated: we need outcomes for orthopedic surgeries, results of exit interviews from patients, incidence of hospital acquire infections, surgical complication rates for at least the top 10 most frequently performed surgeries, some general morbidity and mortality information that we can understand.

    we are told to ‘shop’ but all we can see (if we are very, very lucky and find someone who knows) is the price. The quality information is carefully kept from patients in most cases. This is not true in most countries with well developed healthcare systems…

    It the patients who need to be whining.

    • Kurt
      March 11, 2016 at 2:25 pm

      Lemme tell you about your stupid metrics. Who is grading the patients? They leave the office
      after being “educated” and do whatever the “f–k” they want. You see the rates of obesity?
      You see the rates of diabetes? You think the primary care doctors are NOT advising people of their ill ways? Doug is right, primary care is custodial medicine no one else wants to do. At least he stands a better chance that his patients might listen to him since they are directly paying him.
      Same thing with MOC. Has that improved the overall health of the nation? Only thing that does
      is improve the income of the so called medical boards so their directors can make 5 times more money than their “diplomates” who actually see patients. Who wants to be a nursemaid, guardian angel, secretary and health policemen. No paid enough to do the first three and can’t be a policemen as there are no consequences to the person who fails to follow medical advice.
      (Quite a frequent occurrence in a rural area with the less educated.)
      Metrics are only dissuading physicians from seeing difficult patients. Where I was willing to take a chance to work with someone in the past, I no longer risk making an attempt because it might
      make my “numbers” look bad. One has to be insane to go into primary care medicine these days. Kurt

  2. March 10, 2016 at 11:18 am

    So. TL;DR — metrics and data, when ignored, are a waste of time and money and do not improve quality. Duh.

    I get the issues about irrelevant metrics and clumsy reporting. Been there, done that.

    But putting those aside, there are far more interesting questions than the rants above.

    How ARE practices actually working to improve quality? If they’re not using the data they report.

    My own experience would lead me to believe that most aren’t particularly focused on overall quality. Each practitioner’s trucking along, giving it their best shot, informed only by their own opinion about how they’re doing, for the most part.

    The only reason there’s any discussion about overall quality is because external metrics are demanded.

    Or, if they’re using data to look at overall quality — OTHER than that data which they track and ignore, per above — which data would that be?

    • Doug Farrago
      March 10, 2016 at 7:56 pm

      Define QUALITY for me and I can answer you.

      • March 10, 2016 at 9:09 pm

        That’s at the heart of my question. Not how do *I* define it. But left to their own devices, with no external demands for metrics or quality, what overall quality metrics ARE typical practices focused on? If any.

        Not what are the very best practices doing, but what’s *typical* for a given type of practice.

        (With all the obvious caveats about the differences between, say, a family medicine or ob-gyn practice vs, say, a neurology or infectious disease practice.)

        • Doug Farrago
          March 11, 2016 at 6:51 am

          Left to their own devices? You are caught up in the brainwashing that doctors need to be watched all the time, that they can’t be trusted, and that they have been doing bad care for decades. There is no evidence of this. Four years of college, four years of medical school, and three or more years of residency working 80 hours a week is somehow not good enough? All this is the dogma used by the insurers or the administrators to control doctors and to break the trust between patients and doctors. It is a farce. Who is grading you, Leslie?

          An independent doctor or medical practice, like a DPC, needs to give comprehensive, accessible and personal care or they will go out of business. How is that for a metric?

          • March 11, 2016 at 10:05 am

            Not a very good metric, actually, since it says nothing about how good a job of providing care the practice does overall.

            PS Not sure why you’re conflating formal education with patient outcomes? Two very different things.

          • Doug Farrago
            March 11, 2016 at 8:29 pm

            Okay, so I think we have hit a brick wall here and that brick wall is you. You are the reason I created this blog. The tag line use to be, “Taking back control from the idiots now in charge of the healthcare system”. I am sorry I changed that now because this conversation proves my point. You are brainwashed because you are an administrator. You cannot change your mind. Though there is no proof metrics do ANYTHING when grading or paying doctors, you continue with your argument never letting the facts get in the way. You are reading all the great points that disprove your comments but hear nothing. This is why the fight goes on. Feel free to continue to read this blog and maybe use the search button to look for other “quality” posts. Maybe, just maybe you can learn something and be more open-minded. But if you to continue to act like an administrator then my guess is this will continue to do nothing for you.

        • rsw
          March 11, 2016 at 2:15 pm

          “what overall quality metrics ARE typical practices focused on?”

          Uh . . . maybe the same ones used by your lawyer, your accountant, your priest or rabbi, your architect, your favorite concert pianist, your most admired author . . .

    • Pat
      March 10, 2016 at 9:05 pm

      “…because external metrics are demanded.” Precisely. The entire “quality” industry is the next level of controlling physicians. The explicit idea is that individual doctors can’t be trusted to do excellent work, and need oversight from insurance companies, government agencies, and organized medicine, all of which have their own agendas.

      “Demanded”. Doctors long ago should have demanded to be left alone, and refused to buy into this scam.

    • Pat
      March 11, 2016 at 2:29 pm

      Leslie, the costly, bloated, and otherwise useless parasitical industry of “medical service consumers” (excluding actual patients) and those who have empowered themselves to make external demands are exactly the problem. By definition, all those who make money off doctors’ years of work and investment have therefore assured themselves that the doc’s have to watched – and must be watched by those with no expertise, but a fiduciary interest in the watching. This is corruption, and justified with the implication that doctors are generally corrupt. Most patient visits could be legitimately, correctly done on a 3X5″ card, without all the stupid repetitive review-of-systems, the re-recitation of every medical problem, or inquiring as to whether the patient still smokes or feels safe in the home. When I talk to another physician about a patient we certainly don’t go over all this crap, because unlike the rest of the health industry, we actually know what we are talking about and don’t want to waste each other’s time. This quality yoke is only useful to those with no medical expertise, who wish to deny payments while cashing their own checks.

      Doug is entirely right, the most critical metric is whether we do a good job. How is that decided? How about between patient and doctor? If I don’t like my mechanic, or my roofing contractor, I certainly don’t need a legion of intermediaries to speak up for me.

      Without physicians no quality merchants would, or could exist, yet they only get in our way, get between us and the patient, and make most of us long for the day when we can get out of this godawful industry. They drive up costs, suck whatever fun was left out of the process, and make everything more expensive. And there is no evidence that they do any good whatsoever. Other than that, “quality” preachers do a great job.

  3. Kurt
    March 9, 2016 at 11:22 am

    If a physician is not seeing patients, most of whom can leave the office and not follow the advice
    given anyways, they need to be cast into Gehenna.

    I see insurances turning down generic drugs now too. I can’t wait to retire from this medical
    custodial work. Kurt

  4. Steve O'
    March 9, 2016 at 8:57 am

    “Which one of you is the bad doctor? …Stop Whining and Start Leading…It’s about how physicians need to stop complaining. Effective cultures require strong leadership.”

    Umberto Eco wrote a nice analysis of what the elements of Fascist thought are, back in 1995. It was a handbook to identify the characteristics of Fascism – a Bird-Watcher’s Handbook to recognize the various species.

    Halee Fischer-Wright, MD is obviously not a physician, but a Leader of Physicians. She is one who does the thinking, and spurs the troops to action. Not everyone can lead, of course – only the elect. This is, as Umberto Eco described it, the cult of action for action’s sake. Action being beautiful in itself, it must be taken before, or without, any previous reflection. Thinking is a form of emasculation. Therefore culture is suspect insofar as it is identified with critical attitudes. Distrust of the intellectual world has always been a symptom of Ur-Fascism, from Goering’s alleged statement (“When I hear talk of culture I reach for my gun”) to the frequent use of such expressions as “degenerate intellectuals,” “eggheads,” “effete snobs,” “universities are a nest of reds.”

    People like Fischer-Wright were seen forty years ago as physicians who had renounced the profession to go into business. The leadership was that of scientific medicine, as praised by Flexner. Qualifications for standing as a medical leader involved publication of work critically reviewed by one’s peers.

    The New Revolution reminds us that medicine was an atrocious mess when physicians were left to think for themselves. There was no slow accumulation of a rational basis for medicine before The Revolution. Nobody paid any attention to the costs of medicine before Obamacare, to efficiency and quality – no, you DON’T have to look it up! We told you once.

    In the new hierarchy, doctors are told that they can start thinking – at the point at which they accept the Leader’s observations. All one has to recognize is that Doctors are the problem, and Doctors need to confess their failings, like Mao’s Cultural Revolution, and go off to the countryside for re-education. “In modern culture the scientific community praises disagreement as a way to improve knowledge. For Ur-Fascism, disagreement is treason.” Eco

    “Fascist schoolbooks made use of an impoverished vocabulary, and an elementary syntax, in order to limit the instruments for complex and critical reasoning. But we must be ready to identify other kinds of Newspeak, even if they take the apparently innocent form of a popular talk show.”

    Asking questions that are too long, with too many hard words, is ungood. Leaders like Fischer-Wright offer phrases to take up the space formerly held by actual thought – a new model of care – care teams – reporting on quality metrics – increased use of technology – quality of patient care – improving records management – optimizing workflow – meeting HIPAA compliancy requirements… All of these are baby-school management concepts, middle-school management theory, and every mom ‘n’ pop practice in the sticks followed them instinctively.
    What is “novel” is the hierarchical impress of rules to follow rather than ideas to obey.

    Quality measures DO work – they reassure the organization that the CHECKERS are the good guys, and they are handling QUALITY METRICS to identify the KILLER DOCTORS. The Gestapo and the KGB – they kept meticulous records, of course, on the criminals and thugs and assassins which they caught and liquidated, to save the State. You’d think that fascists would be sharp enough NOT to keep records on their crimes, but at the time, they were quality measures to show the Politburo how useful they were, to justify their own existence and the bills for those fancy uniforms.

    Remember this phrase – you heard it here. HEALTHCARE IS A NATIONAL SECURITY ISSUE. When we start waking up and getting TOUGH on the enemy within, and really take this problem as a national security crisis – then you’ll know the fat’s in the fire.

    Ref: http://www.pegc.us/archive/Articles/eco_ur-fascism.pdf

  5. Pat
    March 9, 2016 at 8:01 am

    I like how this opportunist was trying to groom “physician leaders” to become efficient drones (she could have asked Doug about his experience in that role which he recounted last week). “Leadership” has become as toxic a term as quality, the former being used to beat physicians over the head so that they will adopt the latest dogma without questioning, and then in turn beat others into similar acceptance. Fischer-Wright is just the sort of sell-out that Big Insurance and Big Gov’t would try to sell now as a model to emulate, where “leader” = “tool.”

    “Which one of you is the bad doctor”? How about the one selling her colleagues out to an unworkable system, in exchange for fat bucks and speaking gigs?

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