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What's Wrong With Healthcare Quality Measures? Part II

Cheryl Clark, for HealthLeaders Media, November 21, 2013

10. Poor Competence is Hidden
Knowledge of poor provider competency, especially among surgeons, is well known among medical staff, operating room nurses and techs. Yet it's unclear whether most, or even if, any hospitals have a system to curtail that physician's practice until remedial training shows sufficient improvement.

On the contrary, the usual course of business is to stay quiet, and let malpractice insurers and lawsuits weed out the inadequate providers, eventually. The reason: There's fear the poor performer might file a claim against colleagues claiming restraint of trade.

11. There are Too Many Measures
How many is too many? Let me start counting them. There are measures under the Patient Protection and Affordable Care Act that carry financial penalties that eventually will total as much as 6% of a hospital's federal reimbursement. There are private registry measures and federal measures to obtain meaningful use incentive payments.

There are pay-for-reporting measures, emergency department speed-of-care measures, surgical measures, and process measures. There are private measures from third party non-profit organizations that rank structural improvement initiatives, such as computerized physician order entry systems.

Panzer and colleagues sum up their findings by saying that "although the current state of healthcare is, on occasion, disorganized, inefficient, confusing and misleading, it is better now than prior to the Institute of Medicine's reports To Err Is Human and Crossing the Quality Chasm, when many incorrectly assumed that patients were uniformly safe and care delivery was always efficient and reliable."

If that's true, and things are better, the fact that we now measure such things is certainly the reason. But we need to get much better at it, in a way that people can understand.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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1 comments on "What's Wrong With Healthcare Quality Measures? Part II"


robert plass (11/22/2013 at 11:44 AM)
Good summary. Expanding on item #4, there is a difference between statistically significant and clinically or administratively relevant. Patient satisfaction scores similarly exist within a very tight range. So the difference between 80 and 85 on a scale of 100 may have a significant impact on where that score falls in a percentile ranking (50th vs 80th percentile for example). But does the difference between an 80 and an 85 really mean anything relative to patients recieving those services? Currently, there is too much emphasis on process measures rather than outcome. Giving education to patients relative to stopping smoking seems like a good idea, but does it really have an impact that improves health? What is actually being measured is whether or not the information being provided is DOCUMENTED, not even whether or not it was given, given in an effective manner, nor whether or not it caused any harm to fail to provide that information or benefit from providing it. Relative to #10, many hospitals actually have a system that evaluates performance quite well, but like many HR functions, the results are not advertised. The emphasis needs to be on education and improvement, not punishment. Also, it generally takes a pattern of mistakes to indicate a problem, since any given doctor can and will have a bad outcome at some point, but that makes them human, not a bad provider. Many of the measures are simply THOUGHT to be a good idea without any data to back up whether or not that is actually true. Some measures come and go because what was thought to be a good idea is subsequently proven to be wrong or to even be causing more harm than good. There is also significant variability between the INDIVIDUALS who are entering the data as well as the hospitals they work for. As strict as the criteria are, there is some room for judgment and it can be hard to always follow the guidelines precisely and to the letter. So, it sounds like a good idea to measure, and it can be. But even the medical literature that is supposed to create the evidence that "evidence based medicine" is based on can be quite flawed, misinterpreted and may not be replicated in subsequent studies. So, understanding the limitations of the data, and being cautious with interpretation is paramount.