Doc performance tracking: Key to quality or Big Brother?

Though doctors fear that "some bean-counter will decide what performance is," hospitals around the country increasingly are monitoring physician performance against established care goals, reports The Wall Street Journal.

Docs don't necessarily appreciate the oversight. The WSJ article reports cardiologist Venkat Warren, M.D., one of the physicians practicing in California's MemorialCare Health System worries that providers will be pushed to avoid older, sicker patients who could drag down their numbers.

It cites three factors at work: more physicians going to work for hospitals, computer systems to crunch mounds of data from their patient care, and deals with insurers moving away from the fee-for-service model.

Healthcare reform is central to this number crunching, with hospital reimbursement and penalties from Medicare linked to their performance on quality gauges. It targets in particular costly readmissions. The push toward Accountable Care Organizations also rewards improvements in efficiency and quality.

Many challenges remain, though. Nine Pioneer ACOs have said they may drop out of the program unless the Center for Medicare and Medicaid Innovation revises the quality benchmarks they must meet to qualify for Medicare bonuses.

Tracking the number of tests docs order, as well as their patient-mortality and complication rates, among other measures, isn't a new idea, the WSJ story notes. It notes an effort in the 1990s produced mixed results, but failed financially and doctors pushed back.

New technology, the story says, provides faster tracking of physician practices. Hospitals, leery of sparking physician revolts, are treading carefully, speaking of "aligning" with physicians rather than serving as Big Brother.

New ways in which physicians are paid--models linked to various performance measures--are forcing doctors to think differently about how they provide care,  two recent compensation surveys suggest.

MemorialCare's chief executive, Barry Arbuckle, told WSJ that tracking physician performance is "absolutely key" to its plans to improve efficiency and quality.

"Do we control physicians? We don't try to," he said. "We just try to use process and information to get them to that same point."

To learn more:
- read the WSJ article (subscription required)

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