Newtown, CT – March 18, 2016
A funny thing happened on the way to the Forum, but the masquerade didn’t end up amusing. Especially not for patients – In that inimitable way in which the National Quality Forum pretends a consensus process when, in fact, its gateway is jealously guarded by those whose notion of physician accountability is: “not on my watch”, this week’s review of measures considered for endorsement provided another cynical act of subterfuge. A number of measures were simply being reviewed for maintenance, having been previously endorsed. That routine process is usually straightforward unless a measure previously endorsed has changed its shape, perhaps by having shifted the locus of accountability from, say, a hospital or health system, to a practice or even an individual physician. That was the case for our measure of potentially avoidable complications during a pneumonia episode. And there were also some new measures proposed, including a comprehensive asthma control measure submitted by our friends at MN Community Measurement. The Pulmonary and Critical Care Standing Committee made short shrift of these two outcomes measures, given that they were the only ones calculated at the physician practice or group level. Of course, that’s not a real surprise to us, and at least has the virtue of consistent cynicism. However, it’s not funny. In fact, quite the opposite.
What this means to you – There’s something really wrong with the current process to get measures endorsed and it’s getting worse, partially because physicians are realizing that the stakes have risen. When our PAC measure was originally endorsed, most policy makers and others in our field were talking about the importance of accountability for outcomes of care at the clinician level, but no one was really doing anything about it. That has changed, and physician lobbies are realizing that measures are now being used to assess differences in performance and that those differences will count in Medicare payment formulas like MIPS, and in many private sector initiatives. Unfortunately, these same physician lobbies are now the gatekeepers for all measure endorsement processes, and we have heard loud and clear from them that they will simply not allow broad outcome measures, or measures whose results can make them look bad, to get through. Note that the MNCM measures and ours are reverse images of each other. If a physician scores well on the optimal control measure, they will score low on PACs, and we know this from studies we’ve conducted. Conversely, physicians with high PAC rates aren’t likely to score well on MNCM’s optimal control measure. And given that the baseline performances aren’t very good on either measure, physician scores on each are, on average, pretty bad. That’s ok in the MN culture, and it’s ok in many other parts of the country where physicians take accountability seriously, but in the putrid streets of Washington DC, where accountability is a four-letter word, it’s not ok. And so the masquerade continues, with pretenders faking objectivity all the while asserting their strong biases against any measures that will make physicians look bad. These people chose to ignore that the quality of care metrics we and our colleagues spend time crafting, testing and validating aren’t about them but about their patients. What we care about is making sure patients get the best outcomes, but we’re the real fools because we actually believe that those who sit on these Committees have the same aspiration when, instead, they only aspire to protect their own outcomes. Shame on them, and shame on the Forum for allowing this masquerade to continue.
Francois de Brantes