With the SGR bill passed, is the cup half full or half empty. I believe it is almost full, but some are already complaining that “we gave away too much”. The half empty crowd sees the quality payment piece as the poison pill in the bill. They opine that “we gave away too much”.
Anyone who reads this blog knows how I rant about quality measurement. That term is an oxymoron. We cannot measure quality because it has too many dimensions for even an advanced mathematician. We measure performance and that does not equal quality.
Talk to non-physicians about their concept of quality and it does not fit the measures we use generally. They want a correct diagnosis (virtually immeasurable), a caring bedside manner, explanations that fit their understanding, knowing the plan and having input into that plan. They want good care, but on their terms. They often do not want undesirable side effects from medications even if those medications are proven to help their disease. They are usually not disease focused, but quality of life focused.
Our performance measures are not patient focused, rather they are generally disease focused.
That being understood, the new bill does not change the performance measurement landscape. This problem of performance measurement already permeates health insurance. We all need to work to better define quality and demonstrate to the politicians and bureaucrats that their regulations are harming quality health care. We need to demonstrate the unintended consequences of many performance measures. We need to heed Onora O’Neill, the practical and outstanding British philosopher who wrote:
Yet faith in performance indicators is hard to dislodge. Every time one performance indicator is shown to be inaccurate, shown to encourage perverse behaviour, or shown to mislead the public, eager people imagine that they will find other performance indicators free of such adverse effects. Experience suggests that they are as mistaken as those who produced the last lot of indicators.
Getting rid of the SGR allows us to focus on this problem. We had to remove the SGR threat. We have performance measures and we must show their problems. We must call on researchers to continue to document the weakness of most measures.