Monday, May 16, 2011

What Quality Means Now: Checkboxes

With the news that Wellpoint, one of the largest insurance companies in America, will cut off annual 8% payment increases to about 1,500 hospitals if they fail to "test" high enough on 51 quality measures, they have officially defined "quality" health care as checkboxes.

Yep, checkboxes.

You see how do insurers know if we offer each of our patient's nutritional guidance or exercise counseling?

Well, they check to see of doctors have clicked on a yellow warning box advising we do this. If we have, then not only is that doctor a fine, "quality" doctor, but the hospitals (and it's computer system and scores of administrative staff that compile and submit this data) are real, fine, "quality" hospitals.

That's all there is to it.

Never mind if we don't have time to actually perform the counseling.

* click * * check * * click *

Simple as pie. Efficient, too.

Beautiful bureaucratic quality.

Good luck with that.



Keith said...

It has long befuddled me that we depend on health care providers to essentiallly provide their own statistics on quality indicators. And as best as I can tell, there seems to be little to verify that results are accurately reported. Maybe this is why, as you reported previously, there is little room distinguishing the supposed high quality providers from the bottom of the barrel.

Look for more fraudulant activity as insurers and goverment try to tie payments to quality measures. Certainly the one subtle way to commit this fraud is to document things that have not been actually done.

On the other hand, so much of these quality measures don't really belong in hospital settings to begin with. Is it really necessary to worry about giving the patient a pneumococcal vaccine while they are hospitalized for some other medical issue? Or to counsel them about tobacco use during their hospitalizaton?

These activities are important, but this is the wrong setting to perform them in.

This will be the big issue in driving quality care. There are not clear definers of what quality looks like and in many cases they are not proven to increase health. So will we simply be spending more time clicking boxes which means spending less time in the activities that really constitute good care?

Tim said...

I was appalled to learn that our nurses are required to do all this counseling when discharging a patient! If he has 5 patients to discharge, what time is left for actual patient care? Is this counseling not the responsibility of the primary care physician? Does the nurse know enough about each paitent to know how to counsel appropriately? How does she know she is not contradicting what the doctor has told the patient? Nuses don't always have time to round with each physician. That would take away valuable computer data entry time!