The Medicare Payment Advisory Commission’s (MedPAC) recent report to Congress provides an important and thoughtful rethinking of how quality is measured in the health care delivery system. The report lists 3 major critiques of the current way that quality is measured. First the current regime relies too heavily on “clinical process measures” that may lead to both the overuse of services and may not even correlate to better health outcomes.
Second the administrative burden has gotten out of control (see table). According to our calculations based on MedPAC’s data, the number of measures in the Medicare Inpatient Quality Reporting program will increase 480% from 2005 to 2016. That does not include intuitional and other quality measures a doctor may be required to address. A previous Hippocratic Musing post speaks to doctors’ anger over paperwork.
Finally MedPAC explains that the current measurement system pushes resources into the clinical process at the expense of other interventions that may have a greater affect on health outcomes. MedPAC writes “As a result providers have fewer resources available for crafting their own ways to improve the outcomes of care, such as reducing avoidable hospital admissions, emergency department visits and readmissions and patients” experience of care”(41)
In short, we would argue, quality measurement has an important relationship with doctor autonomy. Similar to the Heisenberg Uncertainty Principle; you can’t measure quality without affecting it. In this case the rage of options open to the doctor is, to some extent, defined by how quality is measured.
MedPAC calls for rethinking the current quality measurement regime. They call for smaller measurement programs and population based outcome data as the centerpiece of quality assessment. (47)
Taking MedPAC’s rethinking of quality measurement to heart, we also have to ask how new models of quality measurement would affect both how doctors work and the new types of autonomy that they might create for the doctors. In essence setting up a quality measurement regime goes hand in hand with thinking about the role of the doctor in the contemporary healthcare institution. Could quality measurement inspire doctor innovation? How would population-based metrics change the nature of the doctor – patient interaction?