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The Dual Faces of Quality

Janice Simmons, for HealthLeaders Media, April 30, 2009

It's been a very busy week in Washington, DC—especially if you cover issues related to quality and healthcare. From the meeting rooms of the American Hospital Association's annual membership meeting to the floor of the U.S. Senate to a federal hearing on meaningful use and health information technology, the word has been there: quality.

Quality care is the goal—as well it should be—in reforming the American healthcare system. Who can argue with paying more to hospitals and physicians meeting quality standards? And don't we want to know more about treatments that provide us with quality care? And, how can we eliminate medical errors and improve patient safety and quality care.

But one piece of the picture may be missing. What about the people on the receiving end of that care—which is basically you and me? Of course, we don't want poor or substandard care. But recent polls show that American public may not be totally on board with proposals to change their medical care as much as policymakers think. What may play well in the halls of Congress may be met with some unease in the streets of Peoria or Pittsburgh or Portland.

In the past months, many studies and reports have come out that showed how quality care can be achieved, for instance, through better use of health information technology (HIT) or new Medicare payment methodologies.

But as Peter Neupert, a corporate vice president with Microsoft Health Solutions Group, said at an April 30 presentation on getting HIT right: "Consumers don't want data. They want to make their lives better."

This subtle disconnect between what policymakers want and what consumers want was illustrated in a survey released last week by the Kaiser Family Foundation, National Public Radio, and the Harvard School of Public Health.

An interesting response appeared that included questions about getting medical tests. When asked if too many patients were getting medical tests and treatments that they don't really need, 67% responded it was a major problem, 39% said a minor problem, and 9% replied it was not a problem.

However, when asked if too many patients were not getting the medical tests they needed, a surprising two-thirds (67%) responded that it was a major problem, with 24% saying it was a minor problem, and 7% not a problem.

Also, another question asked was if an expensive medical treatment has not been proven to be more effective than other less expensive treatments, should insurance companies pay for it? More than half (56%) thought the insurance companies should pay it.

In issues now on the healthcare reform table, such as comparative effectiveness research and other quality-related issues, policy leaders are going to need to take a role in convincing people with real-life examples that these ideas can work, noted Robert Blendon, MD, who runs polling programs at the Harvard School of Public Health.

They may want to take examples from other fields such as the use of generic prescription drugs where consumers had to be convinced that generics—even though they were cheaper—were for the most part as good as their more expensive counterpart medications. "We're going to need a lot of examples, and leaders are going to have to sound like they believe that [these actions] are good—that they're not just doing it to cut back on very sick people with care as a way of saving money," he said.

The public will need some more convincing before they say that their physician could be wrong—and a federal panel evaluating treatments is right.

"But that's what leadership is about over a long time—trying to bring people along," Blendon said.


Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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