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    Do quality measures disillusion young doctors?


    I think most doctors can agree that quality metrics do allow for better medicine overall. But is this going to be at the expense of healthy patient-physician relationships? The doctor above questioned whether she wanted to practice the next 30 years getting annoyed with patients who make her scores go down.

     When you are the lowest in the group for quality scores, it is a stimulus to try to score higher the next quarter. (Doctors by nature are a competitive bunch.) Does this mean you discharge your poor performing patients? The patients’ backgrounds, education and socioeconomic status can all contribute to why they make the decisions they do regarding testing and treatment. Physicians have no control over this. We can talk a convincing blue streak and still not persuade a patient to have a mammogram.


    Hot topic: Should medical residents' wokr hours be increased?


    Should doctors be financially punished for this? Also, an indigent patient may be more apt to over-utilize the emergency department even after extensive education by the staff. This will ultimately cause a lower score. Does that mean doctors shouldn’t take care of indigent patients?  My answer is certainly not!

    All patients are entitled to high quality healthcare. This includes patients who refuse that care. Socioeconomic status, education level and background issues should have little to do with who we care for and how we provide that care. Physicians should always offer the best they have to give and appreciate each and every patient for who they are.

    When it comes to quality scoring, even if you suffer the ding, you are hopefully still making a decent living. If all doctors gave up on the noncompliant patients, that would reflect very poorly on our profession.


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    • [email protected]
      We, as physicians, provide a service: medical care. We provide that care and make recommendations for our patients. If they choose not to accept those recommendations, such as colonoscopies or medications or to exercise and lose weight when needed, we should not be penalized for those patient choices. In my opinion, medicine lost its way when we accepted payment based on codes and scores, and not on the time spent taking care of our patients, no matter the outcome.
    • Anonymous
      Dr. Rousche, Thanks for your article. I find it timely and important. I do agree with the previous commenter. What I see in this interaction is physicians accepting a lesser payment for their services. We all know that patients like the one in your post make decisions that don't satisfy 'best practice' requirements. Why should you accept less money to care for them? The argument that we still are compensated well is a canard in this scenario. I would argue that we are starting to participate in a system in which we die a death due to a thousand small bites. You don't notice or feel the first one (or 500), but by the time you realize the problem it's too late to reverse the changes. All the sudden we are merely moderately well paid labor, not the masters of our own destiny. I hope that doesn't come across as too cynical. I think it is easy for large businesses and the governmental payer programs to take advantage of doctors. In the end, we just want a chance to help and positively influence our patients. Ironically your younger colleague has a much better chance of doing that over time without the 'pay for quality' metrics that now color our decisions!
    • UBM User
      Dr. Rousche, With all due respect, this is a cop out of an excuse to end the blog post. What do you mean by "decent living"? Do you really believe that all doctors go into medicine thinking about getting dinged? Why do you passively accept this weird notion that quality can be quantified in the form of metrics? Your young associate is absolutely correct in her inference. Give her some credit please. Your big practice bosses should have the spine to tell Medicare and other insurers that this is simply an unfair and inaccurate way to pay for care. If they insist on metrics, let them eliminate scores from patients who decline standard advice, so scores actually reflect the doctor's role in outcomes. Good technology should be able to do that, if you believe in it. Otherwise, you owe it to your patients and profession to pull out of all such payment arrangements. Just saying...

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