Interesting thoughts from The Happy Hospitalist:
How do you define quality care?…
If preventing 90% of in-hospital DVT’s with a medicine that cost $30 a day was quality, so be it.
What if you could prevent 99% of in hospital DVT’s with a medicine that cost $300 a day. Would the 90% be quality or the 99% be quality? What if it cost $3,000 a day to prevent 99.99% of in- hospital DVT’s?
Which effort would be considered quality? Who defines the cut off, and at what price?
Here’s what he has to say about Pay for Performance measures, and why they won’t add up to significant savings:
Unfortunately, the measures being undertaken for quality initiatives are, from my stand point, minuscule in terms of the overall potential cost savings to the system.
And the reason is simply, at least in my part of the medical physician spectrum, a very large chunk of health care expenditures comes in the form of evaluation, and not management…In the medical profession, there exists a sense of universal freedom to order tests, xrays, labs, and procedures with a sense of unlimited funding. Somebody will pay for it. My patient sitting in front of me is the center of my attention and their needs supersede all other needs from a social/financial point of view of the nation…Where are the government incentives for quality medicine in the evaluation of disease?Where is your bonus payment for not ordering the heart cath?For not ordering the CT Angiogram?Where is your physician bonus payment for not ruling out a low probability DVT?Or not ordering an EGD?For choosing watchful waiting.Where are your quality bonus payments for evaluation of illness?They simply don’t exist. Because doing so would overtly ration the public and create a firestorm.