The Illusion of Quality

The above is from NEJM and is discussed in a recent article on Quality in Health Care. As they note: 

Why has arriving at the essential measures of performance been so difficult in health care, when it seems to occur naturally in other fields? First, in health care we’ve allowed “quality” to be defined as compliance with evidence-based practice guidelines rather than as improvement in outcomes. Of the 1958 quality indicators in the National Quality Measures Clearinghouse, for example, only 139 are actual outcomes and only 32 are patient-reported outcomes. Defaulting to measurement of discrete processes is understandable, given the historical organization of health care delivery around specialty services and fee-for-service payments. 

What this is referring to is that under the new ACA, besides everything else, physicians must report on "Quality Measures", almost the totality of which are fabrications of metrics which have nothing to do with the patient's health. They are  getting messier all the time. The Government process is creating an overhead that is unsustainable, it matches Czarist Russia, with half the population working for the Czar checking on checkers etc. For example I recently was told that a certain Government agency now had statement of work reviews to check proper use of pronouns! Yes, pronouns.

The NEJM article continues:

Second, the limited outcomes measurement that has occurred has been led overwhelmingly by specialty societies. But outcomes are not strictly related to individual specialties or procedures; they reflect the overall care for a patient’s medical condition, in which multiple specialties are usually involved. What generally matters to patients are outcomes that encompass the whole cycle of care — including health status achieved (e.g., survival, functional status, quality of life); the time, complications, and suffering involved in getting care; and the sustainability of benefits achieved (e.g., time until recurrence). Specialty societies naturally focus on their constituents, often choosing measures that physicians can reliably control. The perspective expressed, for example, in a cardiology society’s statement that “outcome measures are highly desirable but often difficult to incorporate into performance measure sets because of vulnerability to influences outside the provider’s control” distances providers from the work of improving patients’ actual results and contributes to outcomes-measurement paralysis.

 The Societies try come up with metrics to meet the Government demands and game the system as well. In today's new ACA world we have physicians using useless EHR systems, they cannot communicate with each other, then they must re-certify, a process which just adds to the cost without adding to quality, creating artefactual "quality" metrics, and somewhere trying to treat a patient.

The process of medicine will soon come to a standstill. It is well above $3 trillion a year and rapidly approaching $4 trillion. These artificial measurements will not only add to the costs but detract from the care.