Point/counterpoint: Does quality reporting improve physicians' clinical performance or hurt it?

Two doctors debate the value of quality reporting.

Does quality reporting improve doctors' performance? Or detract from it? Two doctors take opposing viewpoints in a pair of essays published in the Annals of Family Medicine.

Internal medicine and geriatrics physician David R. Scrase, M.D., argued that quality reporting can improve health outcomes and financial performance. He outlined a six-step model he has used over the past 30 years to improve quality of patient care.

It starts with physicians agreeing on the standard of care to develop measures and ends with improved care and outcomes, said Scrase, from the University of New Mexico Medical School in Albuquerque.

For instance, New Mexico saw the provision of actionable data to physician offices improve overall mammography and immunization rates in patients within a few years, he said.

David L. Hahn, M.D., a family physician in Wisconsin, took the opposing viewpoint, saying quality reporting has not made him a better doctor. Current quality measures don’t address many of the factors important to patients, clinicians and payers, said Hahn, of the University of Wisconsin School of Medicine and Public Health.

“My partners complained that we were 'not making widgets.' I wonder to what extent clinician burnout may be attributable to knowing that one is being judged unfairly by metrics that undermine effective practice,” he wrote.

Measures must be improved to provide actionable information, align with good clinical practices and promote patient-centered care, especially shared decision making, he said.

While the healthcare industry currently uses thousands of measures to assess quality, the Institute of Medicine said in a report last year that providers only need to track 15 core measures or "vital signs" to determine progress.

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The report said the smaller set of measures could reduce the burden on clinicians, enhance transparency and comparability and improve health outcomes across the country.

Hahn said the IOM has created a radically different set of core quality measures and wonders how many years—or decades—before doctors see better measures.