Should doctors take more responsibility for quality metrics?

How do you react when presented with your quality data?

In my experience, physicians generally respond by:

  1. Ignoring the metrics
  2. Arguing about why the metrics are wrong
  3. Saying the metrics are stupid

A lot of doctors refuse to participate in the process of developing, reviewing and refining quality metrics. Although this has the definite advantage of feeling like you’re sticking it to “the man,” it feeds an unhelpful cycle that eventually hurts doctors.

Let’s take these responses one by one:

1. Ignoring the metrics. You can probably do this for a while, but not for much longer. Physician quality metrics are still in their infancy, as EHRs become more widespread and the healthcare system, as a whole, figures out what to do with the enormous amount of data that’s being generated. Medicine is far behind other industries in terms of the data that’s collected and presented regularly.

CMS and hospitals are increasingly led by business people who are used to seeing and using data regularly. Unless you are in a solo or small group practice that’s not affiliated with a hospital system, I seriously doubt you’ll be able to escape some kind of physician metrics five years from now.

Keep in mind that I’m talking about physician metrics broadly — those tied to incentive payments, but also metrics used internally to determine best clinical practices, operational efficiency and patient satisfaction.

2. Arguing about why the metrics are wrong. You are right. Lots of physician metrics are wrong.

I would argue that one of the reasons so many physician metrics are wrong is that physicians have not participated in the process. If there are no doctors helping develop these metrics, it should not be a surprise that the metrics need to be refined (or tossed out completely). You can help improve the metrics if you approach this concept in a non-combative, non-defensive manner.

Be part of the solution:

  • Do some education with the hospital about why the metric doesn’t make clinical sense.
  • Propose a different way to measure the same idea.
  • Advocate for the use of a third party company to verify physician metrics.

3. Saying the metrics are stupid. This one is related to saying the metrics are wrong since sometimes a metric is so wrong that it ends up being … stupid. But telling the hospital that the metrics they are using are stupid does two things:

  • Makes you look like you’re not interested in improving your practice, even though most physicians are very intrinsically motivated to do well for their patients.
  • Makes the hospital very unlikely to involve you in any future discussions of metrics, which means you miss out on an opportunity to make the metrics better.

Ultimately, physician metrics will continue to be a source of strife if doctors don’t engage in the process. If you have metrics attached to your compensation, you will probably lose money if you refuse to engage in the process and/or don’t understand it.

Sarah Gebauer is an anesthesiologist and founder and CEO, Ilumina Health.

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