We have a real challenge in healthcare that won’t be easy to solve. In fact, we may not solve this problem. The challenge is knowing the quality of care that’s being provided by a doctor. This matters for so many things. Ideally we could base reimbursement on the quality of the care as opposed to the volume of care. If we had a good measurement for quality of care, none of us would go to doctors who didn’t provide a high quality of care.
Think about how it currently works. If a doctor’s costs or outcomes compare unfavorably with their colleagues, most of us will say, ‘That doctor’s patients are sicker than other doctors’ patients.” In many cases, that very well could be the case. I remember a similar discussion in the clinic I worked at where one doctor was always given the really complex patients, but then they all wondered why he was always running behind.
The problem is that we don’t have any really good ways to know if someones costs and outcomes are off because they have sicker patients or because they aren’t very good doctors. Plus, this doesn’t even really take into account the long term implications of the care that’s provided by a doctor. Maybe the up front cost was more, but the long term cost to the healthcare system and patient might end up being much less.
Like I said, we may never solve these problems because they are incredibly complex. I know that many people would look to big data to help solve this challenge. Big Data can do great things, but far too often it’s the cop out answer to really addressing the challenge. This is especially true because then it usually leads to us not having the data available for us to really solve the problem.
Even most doctors can’t judge the quality of care that another doctor provides. If it’s a doctor from their specialty that they work with on a regular basis, then they likely have some idea. However, except in really complex patients (which most aren’t), the interaction between doctors is pretty minimal. This isn’t a knock on doctors. It’s just the reality that if a doctor doesn’t have much interaction with another doctor, what basis do they have to know the quality of care another doctor provides?
All of the various doctor ranking systems miss this completely. Most users of those systems mistakenly assume that the ranking or ratings on those sites somehow reflect the quality of the doctor. As discussed above, there’s no way for these sites to assess the quality of the doctor. Instead, these websites rank and rate based solely upon customer service and not quality of care. Customer service can be an important factor in selecting a doctor, but quality of care measures would be infinitely more valuable.
How then do we measure the quality of care provided? I haven’t even mentioned the complexities around consistency of care. Some of my blog posts are better than others. The care provided by a doctor to one patient might be great, and the next patient only good. Plus, this also doesn’t take into account the quality of the patient. What if the patient withholds information which prevents the doctor from providing really quality care? Should we hold doctors responsible for the poor care they provide because of the patient’s choices?
This is a really slippery slope to start, but I’ve heard people talking about it. I’m sure it makes doctors cringe to even think about it. I don’t expect my doctor to be perfect, but I think it is good for doctors to be accountable. That’s just a really hard thing to do.