Time out! Duh!
Sometimes researches seem maddeningly to study the obvious and reach conclusions that completely underwhelm us because they are so obvious. We have all seen and reviewed innumerable articles where the only reasonable reaction is Duh. These conclusions are so self-evident that we want to scream out “why didn’t you ask me?!” since we live with and know these simple truisms every day. There seems to be a flood of easily-forgettable research “breakthroughs” that teach us nothing we did not already know. In addition to wondering why anyone would fund some of these studies and what prompted somebody to waste their time on it, I uniformly concluded that these articles were of absolutely no value to me or anyone else. But one of the recent Duh articles I read may have changed my mind.
Time Out is the title of a May 10 Perspective piece in the New England Journal of Medicine. It was an ultimatum to the world about quality measures, and it came from our organization, the American College of Physicians (ACP). They typically don’t fool around and they always have our backs, so why were they doing a Duh?
Quality Improvement and Value Based Payment are being drummed into our consciousness all the time, as if physicians have never been focused on quality until now. It just happens to be a fundamental part of our professional being and always has been. But measuring it is another matter. Even those of us providing the care do not know well how to do this fairly, reasonably, and substantively without turning the process into a new form of electronic game where the rules and the chase dwarf the actual care.
The stakes are now much higher as the new rules say that all physicians now will or should be paid mostly based on the “quality” of the work they do. And what is the essence of this measurement? A series of 271 measures have been identified as part of the Medicare Quality Payment Program (QPP). Many of these have been endorsed by “guru” organizations that cogitate and define quality these days, the National Quality Forum (NQF) and the NCQA. The QPP program is set to be the process most physicians, particularly in the ambulatory setting, will be defined by (and paid by) in terms of whether they provide high or low quality care.
Regardless of how valid these measures are, it should be a simple process to view someone’s quality since the work performed is already there and documented. But it is instead a crushing burden. Current estimates are that we spend $15.4 billion per year – $40,000 per physician – solely to measure the measures. This saps physician time, physician resources, and physician sanity in a very big way – and the burden is only going to get bigger.
But back to where we started. Are they really measuring quality? We all know the answer is no, but now that truth is more official and unavoidable. The ACP evaluated a big subset of the QPP quality measures being used to measure and pay us, and found that slightly more than 1/3 were valid measures. That means 2/3 of the time we are wasting, boxes we are checking, orders we are writing, and pursuits our staff are engaged in for this program don’t pass muster. This is a national disgrace. Initially done with good intentions – perhaps – but in the rush to do something different we have a massive system of unvalidated or inappropriate measures consuming vast resources without really measuring quality. Duh!
So here’s the part I like. They are calling for a “Time Out”. They want to stop the madness and have somebody get it right before they cut off the wrong limb. It looks like that is all that they are doing right now with these failing performance measures we are all struggling with. Individually we can’t change the direction of this locomotive, but we have to hope that ACP can. They speak for us, they have the ears of some of the powerful institutions, and they have over 150,000 members. They are our best shot at trying to get some sanity back into a chaotic and disruptive process that is harming our physicians and contributing to the burnout rates we are all seeing. Stop! Timeout! Duh!
