Each year, more than 57,000 people who could have been saved die, while $11 billion in annual worker productivity is lost as medicine keeps failing to employ best practices, according to the 2003 "State of Health Care Quality" report from the National Committee for Quality Assurance.
The report blames chronic underutilization of available technology and "irrational" payment systems for the failure.
"Physicians are key actors, but sadly, this is not about physician knowledge," says Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality, a division of HHS. "The real issue is about systems of care."
NCQA is a not-for-profit organization that accredits and certifies healthcare organizations and recognizes physician performance on diabetes and heart/stroke care measures. The reported data is derived from the Health Plan Employer Data and Information Set, or HEDIS.
Failure to use the best available care to treat five conditions--asthma, depression, diabetes, heart disease and high blood pressure--is responsible for nearly 41 million sick days a year, the report says.
Payment systems that compensate physicians and hospitals based on volume hinder the use of best practices and discourage the use of new treatments, the report concludes.
"Even serious medical errors may be financially rewarded if, as is often true, they justify additional charges," it says.
NCQA notes that physician-level assessment and pay-for-performance initiatives that share the savings netted from high-quality care provide incentives for physician groups to be more accountable and transparent.
"Perhaps no other activity holds such promise to drive improvement or to generate useful information for consumers," the report says.
NCQA President Margaret O'Kane says that, with the assistance of health plans, top medical groups that are making "fabulous progress" need to lead the transparency charge among physicians.
"It would help if that tier would step up and say we want to share our data with our peers in a public way," O'Kane says. "But it takes plans to showcase their progress to move forward effectively at the physician level."
The report finds clinical care improved most among those health plans that publicly report performance data. To emphasize the importance of transparency, the NCQA report lists the top 10 commercial health plans based on effectiveness of care and member satisfaction. Performance was notably lower among plans that chose not to report, the report says.
"The trick is that high quality does not happen without physicians being engaged," Clancy says. "But docs cannot do it alone."