Building the Mirror

Earlier this week, CMS announced its latest updates to their Physician Compare website.  This site, required by the healthcare reform law, is designed to provide information specific to physicians related to the quality of care provided.  Although it is currently not much more than a physician directory for Medicare, it will ultimately be designed to make information on physician performance publicly available. CMS is not alone in the payer world in developing access points to provide information on physician related quality metrics. With four clicks of the mouse on the BCBS website, I can find specific information on quality (and cost) for all providers by specialty.  Again, the metrics are not robust, but the information is being developed and is easily available.

Seeing this growing access to quality information in the payer world made me curious to see what was happening in quality on the clinical side of the aisle. Certainly we, as physicians, were “keeping up with the Joneses” on the payer side, so I decided to start with the specialty societies. Even if I couldn’t find physician specific information, I was sure I could at least find some direction as to which metrics should be used to truly define quality in each specialty.  So off to the sites for the American Academy of Family Medicine and American College of Physicians I went, confident the information would jump off the page, just as it did on the BCBS site.  Alas, after 20 minutes of diligent searching, I gave up. Although both sites provided a fair amount of patient education materials, neither one provided any specific information on physician quality or how to best measure it.

As our society continues to demand access to more and more detailed information on all types of purchases, physicians are certainly not exempt.  Most of the information related to quality that is currently available, however, lives with the payers and insurers in the industry.  This information certainly can be valuable in assessing which physician to choose, but does it truly provide an accurate assessment of the quality of care provided?

We are all on a journey toward a system that will rely more and more on measuring quality and value in healthcare.  Who will define quality is yet to be determined, but it appears that those most directly affected by these definitions have yet to fully exercise their voice in this discussion.

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Comments (3) Read through and enter the discussion with the form at the end
Jeffrey DeWeerd - March 9, 2012 9:23 PM

While I am sure that there are many "metrics" being employed by health care "payors" -- (NOT providers as we have our own "metrics"). What do they assume that they are going to gain from these metrics? Better health? Longer life? Improved adherence to the metrics that evidence based medicine employs for the "improvement in health" for our patients? Do they keep track of the statin induced myopathies? The beta-blocker induced depression or increased difficulty in managing COPD with both beta-blockers from our cardiologists at the same time as beta agonists are being prescribed by our pulmonologists? The multi-drug interactions due to the "best practice guidelines" ignoring the best way to improve health (counseling on adequate sleep, routine exercise, healthier diet and lifestyle in general). Metrics that do not seem to be anywhere in play despite the numerous hours I spend working with patients on these exact issues to avoid the complicated world of medicating people to the extent of overmedication -- and to what end -- to meet the "Metrics" so I do not fall out of the "compliant doctor" model. Unfortunately, as we can all see -- the writing is on the wall -- we will all practice cook-book medicine based on the whims of insurance companies - armed with their actuaries - dictating what is "best" for our patients despite the fact that NONE of them has spent one minute of one day getting to know the very people that they are there to help.

When that day comes -- I will hang my stethoscope up -- or become a missionary -- in a place far far away.

Donna Cole - March 11, 2012 7:40 PM

Dr. DeWeerd,
Please don't go... we need you here to fight the good fight against the whims of the insurance companies. Insurance companies (and deregulation overall) have destroyed the art of medicine. Back in the day, being a doctor was a vocation- a calling. So many today enter the field 'for the paycheck'. I am old enough to remember when Drs. made house calls, and medical insurance was something your employer paid on your behalf. Medicine has become big business, and essentially the an economic driver for this country... unfortunately medicine does not promote true sustainable growth, it does not create new jobs, or more jobs and it is not a new industry. - but back to the subject. Insurance companies are not medical people, they just follow the coin. Don't leave, Rage!

Mark Browne - March 13, 2012 9:42 AM

Jeff and Donna, as we continue to build a better healthcare mousetrap, we are all having to learn new skills. I agree with Jeff, that many metrics being employed by those in the healthcare industry do not necessarily represent quality, but there is a movement toward more outcomes based metrics. Quality metrics that are in place now are rough tools, but they are tools and they continue to evolve and be more useful. I agree with Jeff that these tools don't replace the necessary relationship a physician has with his/her patients, but as they continue to improve, one day they will hopefully enhance this relationship through access to real information on quality and clinical care.


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