Quality Measures Fail Again

I think the most consistent thing about contrived quality measures, as a way to pay doctors or hospitals, is that they are pretty much always a failure:

  • Current ways to risk-adjust heart failure mortality as a measure of hospital-level quality are insufficient, suggested a study showing that accounting for do-not-resuscitate (DNR) orders reshuffles institutional rankings.
  • A DNR order initiated within 24 hours of admission was associated with greater odds of in-hospital death (9.9% versus 2.1% without DNR, adjusted RR 3.63, 95% CI 3.17-4.16). Hospitals with more DNR patients reported higher risk-standardized mortality (P<0.001).
  • “Given public reporting of heart failure mortality measurements and their influence on reimbursement, accounting for the presence of early DNR orders in quality measures should be considered,” the investigators suggested.

A few things here to tease out.  If you or your family members are being pushed to fill out DNR orders then they are pretty much going to die.  Secondly, hospitals want their money and they DO NOT want sick patients to count against their grades.  Therefore, they want a way to remove the sickest ones.

Do you see how this quality crap gets a little bit sticky?  It forces hospitals or doctors to concentrate on the things that only get measured.  It makes hospitals beg to have the measuring stick changed.  It gives both groups the tendency to fudge or cheat.

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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] 

  2 comments for “Quality Measures Fail Again

  1. politovski
    September 28, 2017 at 12:11 am

    and, don’t forget, much like elsewhere, when certain things are performing above expectations (ie enron, tyco) it is because there is cheating and fraud

  2. Perry
    September 27, 2017 at 10:10 am

    Basically, it doesn’t matter what you do with the patient as long as the boxes are checked.

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