• Quote: Physician performance measurement program gets an F

    [T]he practical reality is that the Centers for Medicare and Medicaid Services (CMS), despite heroic efforts, cannot accurately measure any physician’s overall value, now or in the foreseeable future. Instead of helping to establish a central role for performance measurement in holding providers more accountable for the care they provide and in informing quality- and safety-improvement projects, this policy overreach could undermine the quest for higher-value health care.

    Robert Berenson and Deborah Kaye, The New England Journal of Medicine

    Here are more concerns from Alyna Chien and Meredith Rosenthal.



    • 1. Interesting observation from the comments section associated with the Chien/Rosenthal piece:

      “STEPHEN BAMBER, MD | Physician – FAMILY PRACTICE | Disclosure: None
      NORWICH NORFOLK United Kingdom
      November 07, 2013
      A view from the UK

      A superb article. Primary Care physicians in the United Kingdom are fast becoming disillusioned by the perverse results of ten years of a policy which fails their patients and themselves, and many are angry that their warnings about the obvious dangers ahead are being ignored. Unlimited free access and social problems have increased demand hugely; there is a 25% shortfall of Primary Care physicians. The hopes and promise of better care from pay-for-performance (P4P) have not been met. In short professional standards are being eroded by it. British Primary Care physicians would be delighted if P4P affected as little as 1-2% of their income; in my own practice the figure is nearly 40%. For the first time the monopoly employer (the National Health Service) may have to face the possibility that its physician employees have a monopoly power too, and may use it: if the latter decide to withdraw their services, there are no other doctors. Some younger ones are openly talking of looking beyond the traditional escape route to Australia and Canada. The USA is clearly very short of primary care physicians: how many well-trained British ones would you like?”

      2. Hopefully the difficulties associated with monitoring quality at the *provider* level will give the health-econ commentariat an opportunity to reflect upon the validity of the current methods used to compare health system performance across geographic regions ranging from the hospital service areas to countries.

      Measuring process-level quality at the single provider level is an impossible kludge, but when you abstract results several stages downstream at the outcome level, across oceans of confounding variables – suddenly the data become robust and meaningful guides to who is providing more clinically and cost effective treatment to their patients?