The Quality Disconnect in Healthcare

There’s a big problem with the current healthcare model. There’s no real financial incentive to make sure you’re practicing the highest quality care possible. Doctors don’t get paid for quality. Patients don’t select a doctor based on the clinical quality of the doctor since the patient has no way of measuring a doctor’s clinical quality. The clinical quality a doctor provides doesn’t move the needle on her business.

Certainly, I’m not saying that doctors don’t provide quality care. It is also true that over time a doctor could grow a reputation as a poor quality doctor, but those are usually only the extreme cases that end up in court with big medical class action lawsuits.

What’s amazing is that most doctors can’t event evaluate the quality of another doctor. An orthopedic surgeon has no way to evaluate how well an ENT is doing quality wise. Doctors of the same specialty could evaluate a colleague’s clinical quality, but that doesn’t happen in the current system.

In a perfect world, we could create payments based on the quality of care a doctor provides. That makes a lot of sense and it’s what we do in a lot of other industries. We pay people who provide higher quality more than we pay people who provide lower quality. The problem in healthcare is that we don’t have any good way to measure quality.

While I believe there’s no good way to measure quality, that doesn’t mean that it won’t keep organizations from trying. In fact, that’s the basis of much of MACRA and the PQRS program before it. Same goes for Accountable Care Organizations (ACOs). These are all efforts to evaluate the quality of care that’s being given and reimburse based on those quality indicators. Most doctors will tell you, that’s not a very good system if you want quality.

What’s screwed up about these quality measures is that they do nothing to actually lower the cost of healthcare. Poor quality care only represents a small portion of the massive premium we pay for healthcare in the US. The real costs come from outrageous drug pricing, pallative care, medical liability fears, and chronic conditions. Those are the four areas we should really be focusing our efforts on. The problem is that there’s not a lot of will in healthcare to address these challenging issues.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

1 Comment

  • Yes. We haven’t figured out a way to define quality in health care. Proceeding with pay-for-performance schemes like PQRS and MACRA without truly understanding what quality is has led providers, in their pursuit of the highest available payment, to standard practice that is not better practice. Providers are paid to chase the red herring. EMR companies develop products that facilitate the pathetic chase. Whatever quality is, it doesn’t improve–it can’t because everyone is chasing the herring. Energy and resources are diverted from innovation and study that would ultimately improve quality, and mountains of money are wasted. It’s a sad thing to watch.

    You are right that even doctors can’t determine who’s good and who isn’t with the present absence of publicly available data. It seems so obvious that there should be a credible repository of annually-reported, specialty-specific outcomes data for every doctor, hospital and surgery center. Outcomes data certainly aren’t the whole story to quality, but they would be a good place to start, a pillar in the shifting sands on which to build.

    Removing price controls would allow market forces to work. If health care providers can’t point to credible evidence that they are as good or better than the competition, price is as good a reason to choose among them as anything else. I can’t think of anything that would move our understanding of quality along–and improve it– as fair price competition among providers.

    Thanks for writing.

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