When it rains, it pours.
So it is with the unintended consequences of performance measurement.
Performance measurement is an important part if our new health care law. The problem is, most of the people who wrote the law have no idea how to define "proper" performance or "quality" care. And when these bureaucrats and political minds attempt to apply individual health care principles to the arena of public health, they simply cannot perceive all of the unintended consequences their policies unleash in turn, especially when payments to physicians are tied to them.
Like a "V-8 head-slapping moment," two important articles have appeared this week, one by Lisa Rosenbaum, MD in the New England Journal of Medicine, and the other on Robert Centor, MD's blog. Each discusses the unintended consequence of performance measurement tied to medical payments: risk aversion.
Rosenbaum's article chronicles how New York's cardiothoracic surgical services are cherry-picking less complicated patients and pairing them with less experienced surgeons in the name of assuring better Medicare payments, and Centor's blog discusses his recent epiphany of the lack of proof of the benefits of performance measures but lots of examples of their unintended consequences.
Yet medicine is inherently risky, especially when caring for the complicated, critically ill, indigent, poor, and uneducated.
This same problem exists with the American Board of Medical Specialties' (ABMS) Utopian vision of improving physician performance by requiring them to perform their highly lucrative Maintenance of Certification re-examinations every six to ten years without EVER understanding the negative consequences of this mandate. No where has any member board of the ABMS ever studied the repercussions of their mandate upon practicing physicians and the patients they care for. Rather than acknowledging the reality that their MOC program is expensive and increasingly tied to physician's hospital credentials and can directly affect their employment, their member boards deflect and create new "design principles" that promise "shared purpose and impact first," to make patients "the North Star," "simplicity and relevancy," to "think internal and external," to "always include the WHY, HOW, and WHO," "to balance the community centered-design with ABIM's expertise and research," to promise "participation and not just communication," and transparent decisions."
I'm not sure I've ever heard such doublespeak to justify the unintended consequences of an unproven and potentially dangerous exercise that could do more harm than good to patient care.
Perhaps as these unintended consequences of performance measurement gain an understanding with patients and legislators, we'll see a change in our health care law that could really help reduce costs and help patient care:
... the dissolution of these needless, unproven, and expensive exercises in futility.