The Quality Inquisition Continues

Who needs proof? Not the “quality enforcers”. Forget the fact that NO ONE can truly define what quality is. Now “Massachusetts is seeking the opinions of thousands of Medicaid recipients about their experiences in the doctor’s office“. This will be fun…and expensive:

Beginning this month, nearly 250,000 low-income and disabled patients will be asked questions such as whether they or their children were able to get appointments when they needed them, whether doctors and office staff communicated respectfully, and whether their mental health treatment actually improved their ability to work or attend school.

I have shown how this has worked for the VA (hint: it didn’t). You could also hit the search bar on this page and type in “quality” for tons of articles DISPROVING this concept. Even the items in the paragraph above can be shredded. Is getting appointments when you need one important? I would think so but what about time spent with a patient? That’s important, too. Well, some docs over so overwhelmed that they can’t see everyone without rushing. Do you see the dilemma?

And here is what they will do with this information:

And the information will allow the state to direct higher payments to better performers. Eventually, officials plan to publicly release some results, allowing Medicaid recipients to compare the quality of provider networks.

It’s the same old story again. The results by this “survey” could be so skewed just by asking the wrong questions. And what if a doctor truly is trying to treat these people in an underserved area but she is the only one? And she has long lines and waits because no one else will help her? The answer is she will be paid less and be publicly embarrassed.

I am all for making the system better for patients. Getting rid of the metrics, which leads to less clicking, is one of my recommendations. This article doesn’t mention ANY of that. It also doesn’t mention that most doctors don’t take Medicaid patients because the payment is so pathetic. All that is ignored as the state government of Massachusetts spends massively for a survey that just cost the taxpayers more money.

Who puts these people in charge of these initiatives, anyway?

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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] 

  5 comments for “The Quality Inquisition Continues

  1. Jennifer Hollywood
    January 21, 2019 at 11:22 am

    “And the information will allow the state to direct higher payments to better performers.”

    What they really mean is the doctors that give out pain medicine, benzos, and antibiotics like candy. Those that order every test that the patient requests despite any data to support that the test is indicated or needed. In short, they will pay more to the doctors (providers??) who give the patients exactly what they want to make them happy. Despite the fact that data clearly shows that patients who get everything they want usually have worse outcomes.

  2. Steve O'
    January 21, 2019 at 10:57 am

    All Hail the Ideology of Quality!

    Why, of course these systems worked well in the past! Among the triumphs of the Soviet Union – look back on the rubbish pit of history – consider wildly successful days of Lenin. There was the Rabkrin (the Workers’ and Peasants’ Inspectorate), established in 1920. Under the more wildly successful days of Stalin, the Rabkrin oversaw as well the party discipline of the Party members in terms of their observance of the program and regulations of the Party, state discipline and Party ethics. Remember that you couldn’t be a playa in the USSR without Party Membership. Your value to the State was exactly the quality that you brought to your work. Obedience IS quality.

    All Hail the Ideology of Quality!
    Ideology—that is what gives evildoing its long-sought justification and gives the evildoer the necessary steadfastness and determination. That is the social theory which helps to make his acts seem good instead of bad in his own and others’ eyes, so that he won’t hear reproaches and curses but will receive praise and honors. That was how the agents of the Inquisition fortified their wills: by invoking Christianity; the conquerors of foreign lands, by extolling the grandeur of their Motherland; the colonizers, by civilization; the Nazis, by race; and the Jacobins (early and late), by equality, brotherhood, and the happiness of future generations…. Without evildoers there would have been no (USSR Gulag) Archipelago.” A. Solzhenitsyn

    Who puts these people in charge of these initiatives, anyway? Well, it’s the will of the People! Except the People are toiling away diligently, so they need an Executive Committee on Party Control to oversee the operations on a day-to-day basis.

    Ideology – that is what gives evildoing its long-sought justification and gives the evildoer the necessary steadfastness and determination… Thanks to ideology, the twentieth century was fated to experience evildoing on a scale calculated in the millions.

    To reject this inhuman …ideology is simply to be a human being. Such a rejection is more than a political act. It is a protest of our souls against those who would have us forget the concepts of good and evil….

    Macbeth’s self-justifications were feeble – and his conscience devoured him. Yes, even Iago was a little lamb too. The imagination and the spiritual strength of Shakespeare’s evildoers stopped short at a dozen corpses. Because they had no ideology…. (Solzhenitsyn)

    This movement is not towards efficiency, productivity, standardization. It is evil to the core, and is part of today’s struggle against fundamental evil in human society. Opponents of “quality” are not quaint or peculiar. We are moral human beings who see the end of this path, the consequences of this lack of belief in human ethics.

  3. Pat
    January 20, 2019 at 11:20 am

    This also ignores the fact that a lot of Medicaid patients act entitled, are very non compliant, often disrespectful, while receiving FREE care.

    Go ahead and rip me, but I don’t care about the opinions of people getting free stuff.

  4. Thomas D Guastavino
    January 20, 2019 at 10:27 am

    Just a taste of how “Medicare for All” is gong to work.

    • PW
      January 20, 2019 at 10:07 pm

      Yes, more like “Medicaid” for all.

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