In "Why 'Quality' Care is Dangerous" Jerome Groopman, MD complains the definition of 'quality' is too narrow, eg: only 'quality' that conforms to consensus standards set by Medicare experts is of sufficient 'quality'.
Consensus means measurement of simple clinical procedures that fail to capture the complexity of medical decision-making, such as diabetic management.
But 'quality' in P4P is meant to capture under-treated aspects of big, high-cost drivers in medicine, like why do so many people suffer from lower back pain (LBP)?
For example, pain is the number one reason people go to see a doctor. A simple zero-to-ten pain scale is more sensitive to clinical change than a comprehensive pain questionnaire yet pain is assessed in less than 50% of the clinical encounters in America.
Why?
One P4P quality metric for physical therapists is pain assessment and implementing a plan of care to treat pain.
Lower back pain has passed cancer spending in research dollars and, prior to 2006, small-dollar, high-volume CPT codes for therapeutic spine treatments were growing at over 35% per year.
Another simple problem in medicine:
Why are so many Americans obese?
Obesity, not disease, is the primary driver of disability in America.
Another quality metric for physical therapists is assessment of body mass index.
While Dr. Groopman could, no doubt, cite examples of complexity in medical decision-making involving LBP and obesity the vast majority of these cases are simple diagnoses that relate to lifestyle factors, not exotic diseases.
There's that old saw in medicine: "When you hear hoof beats, think horses - not zebras"
Show Me the Money!
The biggest, costliest health problems in America are not rare diagnoses - the costliest problems are the result of daily choices we make about diet and exercise.
Dr. Groopman is right, P4P simplifies the collection of basic data which may interfere with complex physician and physical therapist decision-making.
But, it's not the complex decisions American doctors needs help with...
We need help with the simple decisions.
Senin, 20 April 2009
Why 'Quality' Care is Inevitable
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