Because Merrill Goozner wrote today about Ron Wyden’s health care reform plan, I thought I’d post a link to the interview I did back in February with Bob Doherty from the American College of Physicians, the professional organization representing internists.
Anyone else want to chime in with commentary about other proposals out there, so we can compare and contrast?
I read your interview with Bob Doherty of the ACP with interest. While the quality of care was being addressed through a more coordinated patient-centered, primary care approach, there was no mention of the pursuit of quality outcome results and measurements. In other words, where was the ACP on raising obvious question of how the public would know if the value being described here would be real. Please forgive me if this aspect of health care reform was simply not addressed during the interview due to its focus on other matters. But what drives me to bring up the question is a recent survey of internists ( see my: http://ajfortin.com/2007/04/10/internists-survey-majority-oppose-public-reporting-of-quality-scores/ ) in which most internists surveyed opposed public quality of care reporting.
It’s true, the quality benefits of the plan are sort of implied (based on prior research), and there’s no built-in outcomes measurement. There’s also no reason such outcomes can’t be monitored. But it’s an excellent point.
I’m sure docs feel that they’re at the sharp end of the needle regarding quality measurement and reporting; you probably saw Merrill’s post yesterday (http://www.worldhealthcareblog.org/2007/04/24/the-empire-er-ama-strikes-back/) on some comments made at the Congress by the President of the AMA. It’s time for them to be less defensive. And the quality movement has to, in turn, involve docs throughout the process of measure development, endorsement, and actual reporting.
I find it interesting that, in most hospitals (and other settings), it’s nurses who do the work of quality management.
As pointed out in Fred’s link, there are 2 different types of quality reporting about physicians to consider. They strike me as very different:
1) Reporting at the physician group level
2) Reporting at the individual physician level
I think it’s much harder to argue against #1. This type of reporting goes to development and incentivizing tools and processes to improve performance at the systems and organizational level. This type of reporting is very much in line with evolving quality improvement thinking.
I think it’s much easier to make an argument AGAINST #2 — reporting at the individual physician level. I remember one of the points Deming makes in his early writings (I’m paraphrasing) - that about 85% of the time that errors occur it’s a systems problem, not an individual competency issue; however, human nature often (incorrectly) points you to consider personal competency as a cause of errors.
What assumptions do we make about quality improvement in health care? Is the solution in better tools and systems or in better policing of individual physician behaviors? Given the evidence at hand about how little “systemness” we have in health care, I think we’ll get far more bang for the buck by focusing quality improvement on system issues (carrots) vs. individual incompetence (sticks).
I
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