PROFESSIONThe quality quandary: The problems with ratingsAs the movement to measure quality forges ahead, some physicians worry that their patients could be left behind.By Kevin B. O'Reilly, amednews staff. May 22/29, 2006. Can a number tell the world how good a doctor is? A lot of people are counting on it. The government, health plans and employers are demanding a way to quantify the value they're getting for their health care dollars. Patients, faced with higher co-pays and deductibles and increasingly invested in health savings accounts, want reliable public ratings of doctors' performance. Only a third of physicians have access to any data about their own clinical performance, and just a quarter have the electronic medical records systems considered essential for continuous quality improvement, according to a 2003 Commonwealth Fund survey of doctors. Still, a small but growing number of physicians who have assessed the quality of care they deliver as part of maintenance-of-certification and pay-for-performance programs see quality measurement as helpful to care better for their patients. But many physicians, embittered by early and clumsy attempts by outsiders to gauge their performance, have deep concerns about the accuracy and fairness of quality measurement. With more than 100 pay-for-performance programs up and running, according to the Leapfrog Group, and the Centers for Medicare & Medicaid Services asking physicians to voluntarily report quality data, it seems quality measurement is here to stay. Yet as physician groups take over the reins in developing quality measures for payers and the public to use, a quandary presents itself: Could attempts to improve quality by measuring it have the perverse effect of punishing doctors who care for the most vulnerable patient populations? [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2006 American Medical Association. All rights reserved.
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