Sunday, August 26, 2012

"Do or Do Not".... Yoda's 1st Law Of Health Quality And Performance Improvement

"Pay For Performance" May Have No Impact On Patient Outcomes.
The National Journal (3/29, Fox, Subscription Publication) reports, "One of the planks of the 2010 health care law, paying hospitals to improve the quality of care, doesn't appear to help patients survive any better," according to a study published in the New England Journal of Medicine. Investigators "compared two hospital systems over six years – one that took part in the so-called pay for performance plan offered by the Centers for Medicare and Medicaid Services, and one that didn't." Altogether, "more than 6 million patients went through the 3,600 hospitals from 2003 to 2009."
        Modern Healthcare (3/29, McKinney, Subscription Publication) reports that the investigators "say they found no significant difference in overall mortality between hospitals that participate in the program and those that don't."
        HealthDay (3/29) reports, "The researchers also found no differences in results for conditions specifically targeted by the incentive program, such as heart attack and coronary bypass graft surgery."

As many know, Bill Clinton's heart surgeon, Dr. Craig R Smith has some of the 'worst' statistics for heart surgery of any surgeon in the country. Why? because he is such a talented surgeon that he is willing to take patient's considered too high risk by less able physicians. Additionally, as the head of an internationally respected department of surgery committed to meaningful experimental surgical research, both he and his department have mortality statistics that reflect the sometime experimental nature of their work.

What this is all meant to emphasize is that all datum are not created equal. Unfortunately, simple measures of quality are simply that, simple. I would characterize anyone who tries to understand a complex system using simple measurements of that system and who expects profound insights on the system, or enhanced decision making from those measurements to be niave or disingenous.

Again, while I understand the drive to measure and the belief that the process of measurement will make things better, the ability to game the numbers and game the system, especially when such games result in superior renumeration makes the goals of the 'health quality' movement practically unrealizable.  

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