You Deserve the Best Care – How Do You Measure It

By | May 15, 2012

The debate on how to measure the quality of medical care rages in Washington with no clear consensus.

There is a raging debate going on in Washington about how to measure medical quality. There are two basic camps, the first we will term the transactional approach and the second we will label as the results based approach. Both have their pros and cons and they tend to be used by different people with different goals. The transactional approach is currently being employed by HCFA (Health Care Financing Administration) to adjust payment to hospitals and physicians. In this approach CMS (Center for Medicare & Medicaid Services) establishes a set of best practices. Providers who adhere to these practices are rewarded and those who deviate from them are penalized. There are many problems with this approach. One example is EMRs (Electronic Medical Records). HCFA currently penalizes physicians who do not use approved medical records, but there is no convincing data to show that physicians who use electronic medical records are really superior to those who don’t. The other proposed way of measuring quality is to look at how a patient does over time. The problem with this approach is that most patients benefit from the collaborative efforts of loosely defined group of physicians. Even apart from questions of disease severity and individual variation between patients there is the problem of apportioning credit or blame within the group of treating physicians. There is no easy solution to this problem but CMS is pushing for the creation of a vast network of Accountable Care Organizations (ACOs) to do just that. In the upcoming blogs we will examine each approach to measuring quality in more detail and then suggest some simple approaches that we at Schlesinger Pain Centers have found useful in individual cases.

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