Saturday, February 21, 2009

Money, Medicine and Metrics

A colleague of mine shared and article from the New England Journal of Medicine called "Money and the Changing Culture of Medicine" by Pamela Hartzband, M.D., and Jerome Groopman, M.D. The gist of the article is that the practice of medicine had both communal and market characteristics and that currently the balance is skewed towards the market end of things. For example, physicians are pushed by pay for performance, payors and medicare/medicaid to focus on the cost of care. There is currently no carrot for collaboration with peers or even patients. Additionally the article points out that studies have shown that the introduction of financial rewards into almost any situation tend to reduce willingness to collaborate. Scary!

Perhaps change is in the air though. Word on the street is that the National Quality Forum is considering different kinds of metrics. Metrics that measure things like patient engagement in their own care. Not that traditional quality metrics like the SCIP measures will go away but perhaps pay for performance will start to focus on actually changing the culture of healthcare. This is exciting!

We should be careful though. Just as paying physicians based on efficiency alone doesn't necessarily deliver the right outcomes, encouraging physicians who find the right ways to engage their patients to hold those techniques as strategic advantages may be less likely to share what worked. So I hope NQF successfully finds a way to reward and encourage the sharing of such best practices, among doctors and hospitals alike.

1 comment:

Stacy said...

It was a scary article!! I agree with you. We MUST start finding ways to measure collaboration and patient care.