The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) represents 1 ”solution” to physician payment. The idea seems admirable: Pay physicians for providing high quality care.
Making a new framework for rewarding health care providers for giving better care not more just more care.
Rewarding quality seems desirable. Who really objects to rewarding quality? But quality is a very non-specific word and concept. Who defines quality? What quality dimensions will we reward? From whose viewpoint do we define quality measures?
Put another way, do the quality measures address patient concerns. So I propose a thought experiment. What do patients want from their physicians? How do patients define quality medical care?
At the risk of hubris, I will offer some thoughts:
1. Patients want a physician to listen carefully, look them in the eye, and address their concerns.
2. Patients want correct diagnoses.
3. Patients want to understand “the plan”: What is the diagnosis, what is the proposed treatment, what diagnostic tests are ordered and why?
4. Patients want access to their physician, timely appointments, e-mail, text, and phone calls, and do not want unnecessary visits scheduled.
5. Patients want to avoid medication side effects.
6. Patients want cost considered when at all possible.
As we travel down the quality road, I would like to see patients interviewed and consulted about what defines quality. I would bet that their concerns differ from current performance measures.
Like most physicians, I am a patient also. When I have medical concerns, I consider the above attributes.
Please add to or subtract from this list.
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 Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.