The Pay-for-Performance Problem

Aaron Carroll, a pediatrics professor at the Indiana University School of Medicine, writing for the New York Times’ health blog, TheUpshot, has a problem with pay-for-performance, noting that it is meeting with mixed results and some fear that it could even backfire.

Taking a look at a litany of recent studies on pay-for-performance, Carroll writes:

“One of the reasons that paying for quality is hard is that we don’t even really know how to define “quality.” What is it, really? Far too often we approach quality like a drunkard’s search, looking where it’s easy rather than where it’s necessary. But it’s very hard to measure the things we really care about, like quality of life and improvements in functioning.”

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Waiting, and Waiting , and Waiting to See the Doctor.

Few complaints raise more aggravation for our members than excessive and needless paperwork.  While one of the great promises of EHR (electronic health records) was that they would shorten note-taking time, this has not always been the case.

David Himmelstein touched a nerve for many doctors when, in a letter to the editor in the New York Times, he pointed out that American doctors spend twice as much time per week doing paper work as their Canadian counterparts.  Once again the frustration of the patients finds a parallel in the frustration of the doctor. Read More

Health Care Reform: Will Doctors Be Invited?

For the salaried doctor in 2014 there are many questions and few answers.  While the theories about what health care systems and doctors must do to improve care and achieve the triple aim are many, and the acronyms that describe them seem to multiply by the week, we hear little about the experience of the doctor under these new regimes.  Most of the doctors in Doctors Council are part of an ACO and many are part of PCMH and yet when we read the newspaper or a scholarly article on the subject, the role of the doctor as a real person seems to vanish.   Read More

Could Doctor Involvement Be for Real?

In Doctors Council’s recent White Paper and other forums we have argued that fundamental change in the health care delivery system can not be achieved without doctor involvement.  A recent study in Health Affairs: First National Survey Of ACOs Finds That Physicians Are Playing Strong Leadership And Ownership Roles ,makes the same point in relation to ACO’s.  The report concludes “It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for service payment will not be accomplished without strong, effective leadership from physicians.” Read More

Safety-net Hospitals are Different!

Data continues to emerges that it is very difficult to have federal payment systems that do not address safety-net hospitals and their unique patient populations. It is increasing clear that adjustments to the federal payment system for health care must take into account the realities of the safety-net hospitals many Doctor Council members serve.

One study analyzing DSH funding concludes that reductions in DSH funding may disproportionately affect Safety-net hospitals. The study describes a process in California that has important implications for the New York Health Care Market.   Read More

How can I be a Good Doctor?

In a recent blog post from Ashish Jha, Harvard Medical School, he asks what seems like a simple question: What makes a good doctor and can it can it be measured? How would a hospital or patient go about answering this question?  Is it an evidence based question that can be measured using clear criteria such as “good hemoglobin A1C control, regular checking of cholesterol, effective LDL control, smoking cessation counseling, and use of an ACE Inhibitor or ARB in subsets of patients with diabetes”, or is there something more that borders on the art of being a doctor? Read More

Should Performance Metrics be Adjusted for Socioeconomic Status (SES)?

According to a recent draft report from the National Quality Forum (NQF) (see Draft Report for Commenting ):

“There is a concern that NQF’s current policy to not adjust performance measures for sociodemographic factors results in incorrect conclusions about quality. Coupled with use of performance measures for accountability, this could lead to greater disparities in care, due to disadvantaged populations losing access to care as providers become more hesitant to treat them. There is also concern that without proper adjustments, safety net providers may have fewer resources to treat disadvantaged populations. Therefore, the Expert Panel is recommending changes to NQF’s measure evaluation criteria and guidance for which NQF is seeking public comment. Ultimately, the goal of this work is to help the healthcare community reduce disparities in care, while simultaneously drawing accurate conclusions about the quality of care rendered.” Read More