Blog | Monday, July 1, 2013

Finally, an important policy paper against P4P


Rarely does a policy paper stimulate excitement. I have to admit that I did not expect The Robert Wood Johnson Foundation to produce such a document. So bravo, kudos, and congratulations are in order.

Bob Berenson writes about this new paper, Seven Policy Recommendations to Improve Quality Measurement. You can find the policy paper at the Foundation's site as Achieving the Potential of Health Care Performance Measures

Here are their summary recommendations:
1. Decisively move from measuring processes to outcomes.
2. Use quality measures strategically, adopting other quality improvement approaches where measures fall short.
3. Measure quality at the level of the organization, not the clinician.
4. Measure patient experience with care and patient-reported outcomes as ends in themselves.
5. Use measurement to promote the concept of the rapid-learning health care system.
6. Invest in the "basic science" of measurement development.
7. Task a single entity with defining standards for measuring and reporting quality and cost data, similar to the role the Securities and Exchange Commission (SEC) serves for the reporting of corporate financial data, to improve the validity, comparability, and transparency of publicly-reported health care quality data.

While we might have a few discussions at the margins, this policy paper goes directly against some poorly considered mandates in the Affordable Care Act.

Berenson writes: "... I work mostly inside the Beltway in a world of policy makers who, despite good intentions, by their actions often display a lack of understanding of the challenges associated with measures, measurement, public reporting and pay-for-performance. For example, the physician value-based modifier, which was mandated as part of the Affordable Care Act and now must be implemented by CMS, cannot produce a valid snapshot of an individual physician's "value" but will be imposed nevertheless, unfortunately feeding those within the physician community who resist all efforts to improve accountability and transparency of performance."

As much as I have written against P4P at the physician level, I do support P4P at the hospital level, if the measure has good documentation. Central line infection rate should decrease, and incentives should drive the cultural changes necessary to achieve that safety outcome measure.

So I applaud Bob Berenson, Peter Pronovost and Harlan Krumholz for looking objectively at this problem. Their recommendations deserve widespread adoption. We who blog should work to make knowledge of this paper widespread. It is very important, nay, critical at this time.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.