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
