3 experts discuss quality metrics in healthcare: 9 takeaways

Similar to national hospital ratings systems, there is a great deal of variation when it comes to the quality metrics used to evaluate physicians and hospitals because there are no official sets of standards agreed upon by all stakeholders.

The Wall Street Journal discussed the issues surrounding quality metrics used by government programs, insurance companies, professional groups and rating services with three individuals in the healthcare industry — Scott Wallace, a professor at Dartmouth's Geisel School of Medicine in Hanover, N.H.; Thomas Guastavino, MD, a retired orthopedic surgeon from Pottsville, Pa., and Margaret O'Kane, founder and president of the National Committee for Quality Assurance — to get their perspectives on the matter.

Highlighted below are three key thoughts from each participant in the Wall Street Journal's discussion.

Mr. Wallace

  • "Quality should focus on the functional outcomes that mean the most to patients. For a patient who got a knee replacement, can she walk and climb steps? For a man having prostate surgery, can we operate without causing incontinence and impotence?"
  • "Reporting these measures is more complex than looking for a hospital with a single letter grade, but there's no reason it cannot be done in the manner that consumer reviews exist for myriad products and services."
  • "Accountability is a fraught term in healthcare, used too often as a cover to seize financial advantage. Every person who helps deliver healthcare is accountable — to patients. But no caregiver can possibly know whether the obligation to patients is being met without measuring the results of care."

Dr. Guastavino

  • "If you start with the premise that healthcare is unsafe and outcomes are poor, you are doing a disservice to those providers who for years have striven to provide the highest quality care."
  • "Physicians never have had a problem with patient safety. What we do have a problem with is the patently false assumption that physicians had such a cavalier attitude toward patient safety in the past that it now has to be imposed from the outside."
  • "The results of these studies [by rating services] should be used as a starting guideline for providing care but should never be used to create a rigid protocol that a physician must follow and should never be used as a basis for payment. Nothing will ever replace a physician's experience."

Ms. O'Kane

  • "Patient outcomes are the true north of healthcare. If the things we do don't make patients better, then why are we doing them? If a hospital has high infection rates, withholding payment for the expenses associated with infections seems like a reasonable thing to do."
  • "All the variation in what's being measured is a problem. Measuring the same thing in different ways does nothing to improve quality and leads to a lot of disillusionment on the part of those being measured."
  • "We need to map this territory carefully in order to have a system that drives better health in a fair way, without providers being penalized for taking the tough cases."

See their full discussion here.



More articles on quality metrics:
Stakes are rising for clinical quality: How to get the metrics right
Is 30-day mortality a good surgery quality metric for elderly patients?
CMS indicates steadily improving quality measures

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