Here’s what happens when you give so much attention and influence to such a crude instrument.
Following quality measures can make or break a hospital’s reputation, especially if they are being widely advertised. Patients often make health care choices based on whether doctors following quality measures.
However, as these measures are currently constructed, they often ignore the nuance surrounding many cases.
Emergency physician WhiteCoat cites two examples where he failed to follow quality measures, and was labeled “out of compliance” with the guidelines.
In one case, he took the time to perform a CT scan prior to giving clot-busting medications within the specified time of onset of having a potential stroke. Not doing so could have killed the patient, for instance, if the stroke was due to a cerebral bleed.
The second case involved a penalty for not giving aspirin or a beta-blocker after a heart attack, which occurred five days into the hospital admission.
I understand that these quality measures are a work in progress, and to Medicare’s credit, they are constantly adjusting the measures. But it’s important to note that they cannot account for all the decision making that surrounds an individual case.
That means, in some cases, that “bad” doctor may be the only one taking the necessary time and thought that can save a patient’s life.