Opinion Piece Cautions Against Rigid Quality Standards in Pay-For-Performance Programs
Recent research is calling into question "rigid and punitive rules to broadly standardize" patient care in pay-for-performance programs around the country, Jerome Groopman and Pamela Hartzband, both staff members of Beth Israel Deaconess Medical Center and faculty members of Harvard Medical School, write in a Wall Street Journal opinion piece.
They note that the Obama administration "is working with Congress to mandate that all Medicare payments be tied to 'quality metrics,'" but they caution that in many similar programs, "quality measures have been hastily adopted, only to be proven wrong and even potentially dangerous to patients."
They write, "Human beings are not uniform in their biology," adding, "A disease with many effects on multiple organs, like diabetes, acts differently in different people." According to Groopman and Hartzband, "Information evolves and changes. Rather than rigidity, flexibility is appropriate in applying evidence from clinical trials." They continue, "To that end, a good doctor exercises sound clinical judgment by consulting expert guidelines and assessing ongoing research, but then decides what is quality care for the individual patient" and "what is best sometimes deviates from the norms."
Groopman and Hartzband conclude, "Before a surgeon begins an operation, he must stop and call a 'time-out' to verify that he has all the correct information and instruments to safely proceed," adding, "We need a national time-out in the rush to mandate what policymakers term quality care to prevent doing more harm than good" (Groopman/Hartzband, Wall Street Journal, 4/8).