Thursday, January 31, 2008

Dilberts or Doctors?

What do we define as quality care or excellence in a physician? Is it someone who is responsive to your needs, compassionate, caring, communicative, patient, scholarly, or some mix of these?

Or is it someone who checks your blood pressure and lipid panels again and again and tells you to stop smoking?

If you see patients these days, corporate America has decided it’s the latter example.

The Bridges to Excellence coalition of businesses and health plans including General Electric, Verizon, and IBM is now rewarding doctors to provide “quality care” by following cookbook measures. Hell, if you do a good job, they’ll even throw in a $125 gift card for you for each patient you check this way - money they want primary care doctors to throw towards an electronic medical record (before they feed their families, I guess.)

Never mind that the doctors who now collect this small token of corporate beneficence already have an electronic medical record.

You see the Bridges to Excellence has a few little “loopholes” to qualify for that $125 gift card and a gold star. In order to qualify, doctors have to submit their paperwork and documentation of who was “carefully followed.” And only patients over 18 qualify for the program (sorry pediatricians, you’re out of luck). Doctors must prove that at least four of five pre-specified measures of the care have to be met, not just one.

Yep, you need a computer to track this stuff because it’s bureaucratic mindlessness gone wild.

What’s funny (and sad at the same time) is that if we examine the cardiovascular measures for instance, a physician needn’t take part in the “quality care” delivered. Skilled nurses or nurse practitioners could fill the bill. I mean, as long as the “provider” can take a blood pressure, draw a little blood and type in the record that they told the patient to stop smoking, well, – voilá – a “quality physician” is born! A $125 dollar gift card will be delivered to your door and a notation made in the Healthgrades physician database that you’re the highest of high quality physicians. What a deal!

But perhaps a better word for this incentive program is not a reward, but a bribe to do more testing and mindless documentation. Worse, maybe this money is really a kickback scheme to reward the large hospital-owned primary care physician groups (with whom they have contracts); the same groups who already have electronic medical records and teams of gnomes who can sift through these electronically-identifiable “quality” measures. Maybe these refunds will offset the salaries of the gnomes who assure the documentation takes place and constantly remind their doctors to spend a few more minutes clicking checkboxes so the gerbil wheel can continue to spin even faster and faster.

Such incentives do nothing to reward a doctor for taking the time with a patient, explaining their care, walking them through treatment options and reconciling their medicines.

Before handing healthcare over to the Dilberts, caveat emptor.

-Wes

1 comment:

Dr. Val said...

Well said! :)