Chairman's Message => Summer 2005

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What is Quality? => Summer 2005

How do we measure it? Why is it important to you?

We all have a sense of what quality medical care is, but how do we actually measure it? Do we measure outcomes only, processes only, or both? The human body is a very resilient organism. It can take lots of abuse either self inflicted (i.e. smoking), by disease, or inflicted by health care providers (i.e. medication errors) and still have good outcomes. Conversely, we can give the very best medical care available and yet, because of the complexity of disease, have a poor outcome.

Several groups have already developed measures that purportedly reflect quality: The National Quality Forum (NQF), the Joint Commission for Accreditation of Healthcare Organizations (JCAHO), Medteams Collaborative and a consortium of primary care specialty societies (not including the American College of Obstetricians and Gynecologists). Some of the measures may be appropriate, such as antibiotic prophylactic for cesarean delivery, while others clearly do not reflect quality, such as third and fourth degree laceration and VBAC rates (JCAHO).

Despite the obvious difficulty in coming up with the right set of measures, both the Center for Medicare and Medicare Services (CMS) and the Integrated Healthcare Association (IHA) have started pilot Pay-for-Performance projects. These initiatives will reward physicians who meet certain quality thresholds with increased reimbursement. Conceptually, this system has some advantages over the current system that gives higher reimbursements for complications. However, this new system has many potential pitfalls. Do the measures reflect quality? Will data collection be feasible? Accurate? Add additional expense? Will the financial incentives accrue to the individual physician or to the hospital? Will there be adjustments for high risk populations?

The train has left the station. Many payers are considering or already testing pay for performance systems. Physicians must be aware and monitor these developments if not actually participating in the process. If not, then in the future you may get lower reimbursement if your patient has a third degree laceration at delivery.