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Is This Really How We Should Measure Physician Quality?

June 10th, 2009 by EvanFalchukJD in Better Health Network, Health Policy

The OSHA-ization of health care quality continues.

A research group and a consulting firm have been hired by the state of Massachusetts to head up a new initiative to publish cost and quality information on Massachusetts doctors.  But the quality measures they will use are the same old ones we have seen for a long time.  They mean very little to most patients, and even less to doctors as a measure of how good their work may be.

To understand what I mean, look at what is being measured.

For the category “Adult Diagnostic and Preventative Care,” there are only four quality measures.  They are:

• rates of colorectal screening tests
• the number of patients in an insured population who lowered their blood pressure in a given year
• correct imaging test use for lower back pain
• rates of use of a spirometry test for COPD

The good news is Massachusetts doctors do better than the national average on these measures.  The bad news is it’s hard to say what that means as far as how good any doctor is who is measured this way.

Maybe it’s better in women’s health.  There, the four quality measures are:

• rates of breast cancer screening for women 40-69
• rates of cervical cancer screening for women 21-64
• rates of chlamydia screening for women 16-20
• rates of chlamydia screening for women 21-25

Hmm.  So if I am a 30 year-old woman trying to figure out how good my doctor is, the only thing that is being measured is whether he does a cervical cancer screening on me or not.  How about pediatrics?

• rates of well visits
• correct antibiotic use for upper respiratory infections
• follow-up with children starting medications for ADHD

I could go on, but there’s a pattern.  All of these “quality” measures are crunching medical billing data and styling it as a quality metric.  And so every metric is going to be focused on things that are easily measurable by a review of those bills.

But there’s a more disturbing pattern.  The information is simply not valuable to consumers.  Worse, I think it is deeply misleading.  A medical group that does chlamydia screenings on 100% of its patients may be good or bad - or it just may be smart enough to know that if they do the state of Massachusetts will rate them with five gold stars.  But consumers won’t be able to tell the difference. All they will know is that practice A is “high quality,” while practice B isn’t.  Some doctors are starting to sound the alarm about this.

And this is the larger point.  Our health care is organized in a way that systematically undervalues the thinking, processing and deciding aspects of medicine- the things that really matter to you when you’re a patient who is sick trying to get help.  Our system treats medicine as an assembly-line process amenable to assembly-line metrics.  But it’s not.

Doctors, like others in professions requiring judgment and reflection, need time to think, and ought to be judged by how well they do that. Since the leading cause of misdiagnosis is a failure of synthesis - a failure by the doctor to put together available information in a way that leads them to the right conclusion - our system ought to be built around helping make sure this happens each and every time.

So, instead of a web site where you could see how often a medical practice does chlamydia screenings, imagine you could find out how often doctors at a hospital got their patients the right diagnosis and treatment?  Now that would be a useful way to measure quality.

*This blog post was originally published at See First Blog*

Tags: Massachusetts, Misdiagnosis, Physician, Quality, Quality Measures, Screening