Quality measurement and pay-for-performance have major flaws, say speakers at World Health Care Congress

Minneapolis/St. Paul — Quality measurement and pay-for-performance are not without their problems, said participants of a panel chaired yesterday at the World Health Care Congress by a Thomas Valuck, MD, JD, the director of Value-Based Purchasing at the Centers for Medicare & Medicaid Services.

Emily DeVoto, official blogger for the event taking place April 22 - 24 in Washington, D.C., titled her blog entry: “Unintended consequences of quality measurement and incentives.”

Unintended consequences include:

  • Gaming the numbers by cherry-picking patients
  • Making a "measured" area look better at the expense of an unmeasured area
  • Creating a "box-ticking frenzy" which overestimated prevalence of various disorders
  • Perverse incentives related to large performance payments
  • A huge bureaucracy
  • Cynical physicians

Brent James, from Intermountain Health Care, offered an example of the gaming of numbers in patient education. As written by Ms. DeVoto:

“Some clever staff in one hospital overcompensated by delivering an information sheet to every bed in the hospital, whether the condition [on the patient education sheet] was relevant or not, and even what the patient was asleep; the hospital got a perfect score for patient education, but distributing the information this way didn't improve patient outcomes.”

“This report shows clearly how quality measurements and pay-for-performance will not reduce the cost of health care,” said Twila Brase, president of the Citizens' Council on Health Care.

“The panelist's comments underscore our continued concern that pay-for-performance and quality measurement will lead to reduced patient access to medical care, conflicts of interest between patients and doctors, and control of the practice of medicine by outsiders who are not licensed to practice medicine and have no professional obligation to the patient,” she said.

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