Measuring Physicians—and Changing Them


This week’s health policy news roundup curated by Jane Orient, M.D.

Parents are rebelling against Common Core and other standardized tests of their children, which are turning education into a teach-for-the-test treadmill (or else lose your funding). Physicians are also being subjected to a barrage of testing and “quality” measures, as if they were products coming off an assembly line. Those who decline or who don’t measure up could lose their insurance contracts or even their license. Physicians are rebelling also.

The measures in the alternative quality contract of Blue Cross Blue Shield of Massachusetts “have very little to do with quality and really are just meaningless measures,” write Terence Redmond McAllister, M.D., and Leann DiDomenico McAllister. And how can you continuously improve on patient satisfaction scores between 88 percent and 96 percent?

What the AMA calls “innovative payment and delivery models that could improve the quality of care” are tied to electronic health records (EHRs) that even the RAND Corporation, which had long endorsed EHRs, reported neither saved money nor improved care. Just as the $30 billion in subsidies, which helped to induce physicians to comply with EHRs, are running out, Congress enacted the Medicare Access and CHIP Reauthorization Act (MACRA), which imposes an even greater burden of reporting and compliance than Obamacare, writes John Graham.

The effect of “quality improvement” and other demands is that “we are robbed of our mental and physical energy while the demands seem to increase endlessly,” writes a prematurely retiring family physician in Austin, Texas. Anything that distracts a physician from patient care is “no different than distracting a pilot trying to land a plane in bad weather.”

AAPS president Richard Amerling, M.D., writes of the impossibility of defining quality, applying insights from Zen and the Art of Motorcycle Maintenance to medicine: “Quality in healthcare occurs at the cutting edge between subject and object, the patient-doctor interaction. Anything that enhances this relationship improves Quality; anything that interferes with it destroys Quality.”

The AMA, however, advocates indoctrinating medical students in ethical issues that go “beyond the typical ‘patient-physician dyad,’” such as “health disparities.” It appears that even ethics will require extensive reporting and measuring.

Measures that the AMA has voted to develop to test the “competency” of older physicians could be used to sideline those who dissent from the new ethics.

Apparently forgotten is the Heisenberg Uncertainty Principle: the very process of measurement disturbs things. The more precisely we determine the position of an electron, the less precisely the momentum is known.

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