A few months ago I asked the question about whether ACOs were more about good accounting than they were improving care. Here’s a summary of the fear:
I think this is a massive challenge with value based reimbursement. We require certain data to “prove” that there’s been a change in how organizations manage patients. However, I can imagine hundreds of scenarios where the organization just spends time managing how they collect the data as opposed to actually changing the way they care for patients in order to improve the data.
I recently came across an article from HealthLeaders Media which says things may be even worse than I described. Not only do quality metrics not improve care, but they may actually have a negative impact on the care provided.
The article cites a survey by the Commonwealth Fund and Kaiser Family Foundation which highlights this result. Here’s an excerpt from the article:
Of the 1600 primary care physicians surveyed, 55% said the growing use of quality metrics to assess provider performance is having a negative impact on the quality of care. Less than a quarter said that quality metrics have a positive impact on healthcare quality.
Fifty-five percent of the nation’s primary care physicians are currently receiving financial incentives based on quality or efficiency measures. Fifty-two percent cited concerns around programs that impose financial penalties for unnecessary hospital readmissions.
Amy Mullins, MD from the American Academy of Family Physicians also has this zinger of a quote, “It often seems [payers] are measuring to measure, not measuring to improve quality.”
This is one of the major challenges associated with trying to legislate or regulate payment based on quality. If you get it right, then the incentives will encourage providers to improve care. If you get it wrong, doctors will jump through the hoops and care will not improve and may even get worse.
I recently wrote that Digital Health is Hard. I think building appropriate quality metrics that actually encourage improved quality care is even harder. Many say that this is the time when we learn from our experiences. I just feel bad for all the guinea pigs who are being tested on without a choice.