Wachter on Excessive Measurement

Robert Wachter writes in The New York Times about how doctors are harmed by too many performance measures:

the measurement fad has spun out of control. There are so many different hospital ratings that more than 1,600 medical centers can now lay claim to being included on a “top 100,” “honor roll,” grade “A” or “best” hospitals list. Burnout rates for doctors top 50 percent, far higher than other professions. A 2013 study found that… emergency room doctors clicked a mouse 4,000 times during a 10-hour shift.

Similarly, I’ve argued that implementing too many quality standards may actually reduce quality of care:

Clinicians are not automatons following recipes. They have to optimize their time by prioritizing from an indefinitely long list of tasks that could potentially benefit patients. Therefore any requirement that constrains clinician choice has an opportunity cost in terms of the other things that she might do for her patient. Ideally, before setting a standard we should compare the benefit that can be achieved by implementing the standard against that opportunity cost.

Relatedly, Aaron isn’t convinced that measuring quality of care and ‘paying for performance’ based on those measures actually improves patient outcomes. He thinks this is because

too often we use the data that we have instead of the data we need to measure quality. Medicare adjusts its metrics using the administrative information it can find without too much effort. Trying to get more comprehensive information might make measurements more accurate, but would be expensive… But we can’t close our eyes and hope for the best here. Paying for performance, incentivizing hospitals and health care providers to hit metrics, hinges entirely on those metrics being accurate judges of quality. Otherwise, we are pushing the health care system to change its practice in ways that might backfire.

Importantly, Wachter, Aaron, and I aren’t arguing against measuring doctors. We’re arguing for measuring them less, but measuring them better. Wachter:

Measurement cannot go away, but it needs to be scaled back and allowed to mature. We need more targeted measures, ones that have been vetted to ensure that they really matter.

This is a challenge. I’m a psychologist, committed to the view that mental health is essential to well being. Aaron is a pediatrician and Wachter is a hospitalist, and I expect they will emphasize the problems they know best. But we have to learn to see the whole patient and — with patients and families at the table — make hard choices about priorities.


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