Healthcare / Politics

The Quality Conundrum

A recent poll by The Associated Press-NORC Center for Public Affairs Research shows that just 22% of those questioned are confident that they can find information to compare the quality of local physicians. The top characteristics of a high-quality doctor as answered by Americans are, in order, a good listener, the right diagnosis, a caring attitude, a good bedside manner, and knowledge. Many Americans incorrectly assume better care is more expensive or base quality assessment on being personable and available. However as Dr. Elliott Fisher cautions, “some of the nicest doctors are the least competent.” He also debunks more expensive care as better, stating that higher-quality care tends to reduce costs by keeping people healthy and avoiding errors and complications of unneeded care.

The same poll found that 6 in 10 people say they trust recommendations from friends or family and nearly half trust referrals from their regular physician. Very few trust quality information from online patient reviews, health insurers, ratings web sites, the media, or the government.

This leaves us at an impasse. The government is pushing for transparency in quality and price measures, but why bother if consumers do not trust or understand the information? There needs to be a user-friendly and trustworthy system that will allow consumers to compare and choose doctors within their increasingly narrow networks.

There needs to be some sort of overall quality rating system. This year CMS released unprecedented data on Medicare physicians and patient outcomes regarding several chronic conditions. However, this data was very specific. Consumers who do not have diabetes will likely not find quality data focused on management of that particular chronic condition helpful. Advocacy organizations could be looked to as a trustworthy source for chronic conditions-specific physician quality. Leaving the overall quality measures on doctors for generally healthy consumers to the government. There is an opportunity for a streamlined system that is user-friendly and accessible. However as per usual, streamlined healthcare technology and the government do not seem to mix.

Insurers also have an incentive to get involved with the understanding of quality metrics. Generally, higher quality care leads to better health outcomes, which means the insurance companies save money.

Adding to the confusion, the medical community is in the midst of a battle over what exactly makes a doctor qualified. Besides holding a state medical license, around 75% of U.S. physicians are certified by privately run boards in a wide range of specialty fields. Board certification requires physicians to pass rigorous exams, traditionally every 10 years. Recently, many boards have begun requiring doctors to enroll in official Maintenance of Certification (MOC) programs on medical knowledge and practice assessment. These programs require around 20 hours a year in completing modules and taking exams and cost thousands of dollars in order to maintain certification. Most physicians find these modules cumbersome to complete in addition to the continuing-education courses required to maintain their medical licenses. Board certifications are often seen as a gold standard for quality, as physicians are not required to receive the certification to practice medicine and the extra education and rigorous examination are seen as a measure of skill. Certification is voluntary, but many physicians find it required to receive hospital privileges or join insurance networks. Patients would likely see the MOC programs as an advantage for doctors, however doctors are deriding the MOC requirements as costly, irrelevant and time-consuming. The Association of American Physicians and Surgeons has even filed a lawsuit against the American Board of Medical Specialties alleging restraint of trade.

Payers, providers, patients, and the government all have a stake in the race to quality healthcare. There seems to be no way to please everyone and find a way to measure quality. As quality care becomes the highlight of the mission to reduce healthcare spending and improve outcomes, it is unclear how the best way to measure and report quality will work out. In an effort to create a more patient-focused healthcare system, quality comprehension is critical.

One thought on “The Quality Conundrum

  1. “. . . just 22% of those questioned are confident that they can find information to compare the quality of local physicians.”

    “Payers, providers, patients, and the government all have a stake in the race to quality healthcare.”

    Isn’t that the big-picture problem? If we hadn’t come to rely on third-party payers (employers and insurance companies for many of us, government for the elderly) for so much of our everyday care (not just the catastrophic care that insurance was originally intended for), we would have a more direct customer-provider relationship, and our ability to get information and shop around would probably look a lot more like our ability to shop for food, clothes, and anything else that hasn’t been diluted by numerous third-party payers.

    “There needs to be some sort of overall quality rating system.”

    Maybe, but maybe not. We manage to feed ourselves without a government-approved rating system to tell us what’s of superior or inferior quality. We know that Kroger is better than Kroger Value brand.

    “Yes,” you reply, “but the government has regulations to guarantee that everything at least meets some minimal standard of quality or at least safety.” That’s true, but that’s different from a system to rate different levels of quality. Wouldn’t the equivalent of existing food regulations be the government licensing system that decides who can be a doctor in the first place? That and the other existing protections (there are others) should be all we need to guarantee a minimal level of quality or at least safety. Beyond that, get the government out of the way (equalize tax treatment of benefits and phase out Medicare to solve the third-party-payer problem) and let the market take care of itself.

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