by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
My colleague Terry Stoops just wrote a blog post entitled, “let parents sort out quality in the education marketplace.”
The same goes for patients in the health care marketplace. Still, the government is the main arbiter in determining quality health care.
Just look at all of the “quality metrics” doctors have to submit to Medicare in order to get minuscule bonuses. The Physician Quality Reporting System (PQRS) is one example. Established in 2006, the program eventually became mandatory under the Affordable Care Act (ACA). It has since been folded into larger legislation that intends to streamline multiple “big data” quality reporting programs.
Under the PQRS program, physicians choose from over 100 reporting measures that fall within preventative medicine, care coordination, and other categories. Reporting requirements also vary based on practice size. Medical Economics provides some context:
Individual, solo physicians must select at least three measures to report on and meet criteria thresholds, Franco adds. But another option would allow a doctor to choose just one quality measure, such as smoking cessation. The physician would have to report his or her liability threshold—which could be around 30 patients—and document how he or she talked to or educated patients about that measure.
The main objective behind PQRS and a slew of other health care acronyms is to improve Medicare’s population health in the long-term.
But the effort involved with incorporating PQRS in practice management has proven to be burdensome for physicians.More than 70 percent of physicians say that PQRS hasn’t done anything to improve patient care, nor is it making their practice workflow more efficient, reports the Medical Group Management Association (MGMA).
For some hospital-employed physicians whose salaries are impacted by patient satisfaction scores, it can be especially difficult to deliver “quality care.” Not only must they abide by these programs that take time away from patients, they also are pressured by administrators to see more patients per day.
Data is certainly important for measuring quality indicators such as patient health status and clinical outcomes, but that should stay within the physician-patient relationship.
Fortunately, there is a health care delivery model that empowers patients to hold physicians accountable in delivering health care effectively. That’s because patients are the only payer in the examination room. Medicare and private insurance carriers are excluded from this direct-to-consumer practice style, formally known as direct primary care (DPC).
Read more about it here.