Defining good medicine

The Affordable Care Act has, at its center, the goal of flipping the incentives in medicine – from Quantity to Quality.   The ACA penalizes hospitals, for example, when patients get readmitted.   EVeryone seems to be on board – we should pay for “better medicine” and not just more of it.  But how to define what is “better” medicine?

Under the new Medicare Law signed in April by President Obama, Medicare will begin rating Doctors on a scale of 0-100 “based on such factors as quality and efficiency.”  At some point in the future, top scoring physicians will be paid more, and laggards will be penalized.  The new payment formula begins in 2019.  Of course, there is absolutely no agreement on standards for measuring “quality and efficiency.”  According to one source, more than 2000 separate metrics exist that could be employed.

In fact, the medical profession has been trying to go down this pathway for more than 40 years.  Significant differences exist in every report I have seen on outcomes when admitted to hospitals or emergency rooms.  There is also a big difference in quality – for example, we can determine what percentage of men get prostrate checks when they should, but that tells us nothing about the efficacy of any care they receive.

What is clear is that an enormous amount of work remains to be done before any of this can become a reality;  further, IMHO, any attempt to force the issue without agreed-upon and usable metrics, will lead to disastrous and unpredictable patient outcomes.