Quality Reporting and Value-Based Care

The U.S. Healthcare market is now $3.4 trillion dollars and approximately 9 billion claims with roughly 6 percent annual growth. If the U.S. Healthcare Industry were its own country, it would be the fifth largest economy on the planet. Consumers, payers and clinicians are all goal aligned that bending the cost curve is a critical national priority but not aligned with the most effective mechanisms. “Quality Reporting” is the mechanism du jour, but is it the right one? Let's look at the evidence.
 

GM: The jury remains out on this question, which on its surface, appears intuitively obvious to answer in the affirmative. I categorically believe we need to report on the quality of care dimensions, but we must admit the current “science” around “measures” is still in its infancy. Because of this, many clinicians feel quality measures are at present determined in an arbitrary fashion and based on opinion versus real-world and reproducible evidence. Furthermore, quality reporting requirements are more often than not focused on disease-oriented measures as opposed to patient-focused measures. Providers can be forced to choose between focusing on high-level disease measures versus those more specifically targeted to the individual patient. And with payments tied to these measures, a clear conflict of interest can be introduced into the equation.
 

GM: Society, payers and regulatory bodies have focused on “The Triple Aim,” which includes: [1] improving the patient experience, [2] improving the health of populations and [3] reducing per capita costs of healthcare. All noble and worthwhile goals, but I believe we must shift our spotlight to “The Quadruple Aim,” which adds a fourth component: [4] improving the physician experience. Two critical trends that exist in this country are a rising rate of physician burnout and a critical and growing shortage of physicians. Many variables contribute to physician burnout. The costs, complexity, and in many cases the arbitrary nature of “quality reporting,” coupled with their growing financial impact, appear high on the list of etiologies. All physicians want to practice high-quality and high-value care, but in kind, we must also mandate the electronic healthcare vendors have interoperability and lower the design hurdles to make this reporting seamless and part of the normal workflow. We must remove the burdensome task nature of the current systems to fix this problem.
 

GM: Step back, who or why would that question be asked? First, no clear definition of patient satisfaction exists today, but most in the industry calibrate around the gap between the patient's perceived care versus presumptions. The lower the gap the higher the patient satisfaction. Is that a good thing? One well-known study leaves readers with the conclusion that higher patient satisfaction scores are linked to increased healthcare costs and high mortality [Arch Intern Med 2012;172(5):405]. More correctly, we should learn from this study that when patient satisfaction (which is very important) is used as a quality measure, it results in increased spending, increased resource utilization and increased mortality.
 

GM: All current measurement sets, regardless of specialty, only superficially adjust for severity of illness, and none (to date) have any patient accountability. For example, the surgeon with a high infection rate but who has a predominantly obese, diabetic population is significantly impacted by patient choices; events which are wholly out of the surgeon's control. We need a path forward!

A future state where patient-controlled variables are properly attributed and weighed into the quality of care reporting could, with assessments that account for “shared decision making,” more accurately and fairly measure the true impact of healthcare and the professionals who provide it.

To quote William Bruce Cameron, “Not everything that can be counted counts, and not everything that counts can be counted.” Patients and payers rightly deserve and demand high-quality care. Let's just make sure we are measuring the right factors in the correct fashion.
 

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