PROFESSIONAL ISSUES

Education called key to acceptance of performance ratings

The evaluation tools might not be "ready for prime time," but they are definitely on track and heading toward implementation.

By Andis Robeznieks, AMNews staff. Feb. 9, 2004.

Leaders of national health care organizations are saying that performance measures for primary care physicians are inevitable and will be included in the wave of the future that will overtake and transform health care in the United States.

Although attitudes are changing, many experts believe more education on the issue -- for both physicians and the general public -- would make for a smoother transition. A smooth transition also will require easing physician concerns about unfair rating systems or being judged for things beyond their control.

Above all, physicians need some guarantees that the record of their actions will not be used against them in court before they are willing to input their actions into a performance measurement system.

"Physicians don't have any confidence in the tort system," said Yank D. Coble Jr., MD, AMA immediate past president, explaining the resistance to performance measures. "In fact, they have extraordinary dread."

Stephen H. Miller, MD, the executive vice president of the American Board of Medical Specialties, said "society as a whole" would need to decide whether it does, in fact, want health care improved. If it does, he said, it must be willing to remove doctors from an adversarial environment where they can be punished for participating in the improvement process.

Eliminating the fear of legal action will be a major step forward, said Bruce Bagley, medical director of quality improvement for the American Academy of Family Physicians. "I really think that's a major issue," he said. "Because it's such an easy reason for people to duck behind and say, 'I don't want to do this.' "

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