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June 6, 2017

Can quality reporting improve health care? Two physicians clash on the question

Daily Briefing

    Two physicians in separate articles recently published in Annals of Family Medicine detailed their opposite views on whether quality reporting can help to improve health care outcomes and physician performance.

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    Quality reporting can improve performance—but must be made better, physician argues

    In one article, David Scrase, a physician who works in internal medicine and geriatrics at the University of New Mexico Medical School, writes that quality reporting ultimately made him a better physician. However, Scrase also highlights the importance of making quality reporting more effective and detailed steps to accomplish that goal.

    Scrase writes that physicians first must agree on current standards of care, and suggested using guidelines issued by the U.S. Preventive Services Task Force as the basis for those standards. Then, quality measures must be configured in electronic medical records in a manner that matches the criteria physicians agreed upon, according to Scrase.

    Next, Scrase writes stakeholders need to debate in a constructive way whether quality data is "configured properly." He writes, "There simply is no route that can take us from 'no data' to 'good data' without passing through 'bad data.' There just isn't. Instead of just rejecting the 'bad data,' those of us being measured must help those who are doing the measuring become more accurate." Then, Scrase writes stakeholders must work to improve the data by correcting errors to ensure the data are reliable.

    Finally, Scrase writes that stakeholders need to make sure the data being reported are actionable, adding that not having actionable data is "the single most important reason that quality reporting has not yet won the full respect of physicians."

    According to Scrase, taking those steps could help ensure quality reporting leads to better health outcomes and, in turn, better financial performance for providers.

    Quality reporting has limited potential to improve health care, physician contends

    In contrast, David Hahn, a physician who works at the University of Wisconsin School of Medicine and Public Health's Department of Family Medicine and Community Health, in a separate article argues that quality reporting has limited potential to improve health care.

    Hahn writes that quality measures are determined arbitrarily and are based on opinions instead of evidence.

    Further, Hahn writes that quality reporting requirements are focused on disease-oriented measures instead of patient-focused measures. He argues that incentivizing providers to achieve disease-oriented performance benchmarks as opposed to benchmarks related to informed patient preferences in some instances can force providers to choose between providing care that will increase patients' satisfaction and providing care that has been determined a quality medical practice. As such, "a clear conflict of interest exists for clinicians practicing in settings that link achievement of arbitrary benchmarks to clinician pay or other incentives/disincentives," he writes.

    Instead of quality reporting, Hahn writes that quality assessment should be centered on the shared decision making process, in which a health care provider offers patients treatment options and patients make the choices that they feel best suit them (Lagasse, Healthcare Finance News, 5/10; Scrase, Annals of Family Medicine, May/June 2017; Hahn, Annals of Family Medicine, May/June 2017).

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    5 must-have upgrades for the consumer-focused health system

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