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Ways to Improve Family Physician Quality – Measure Other Aspects of Primary Care Capacity Associated With Better Outcomes

July 9, 2017
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In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or practices whether physicians like it or not, or whether it’s really useful and fair or not.

Other aspects of primary care are associated with better outcomes or lower costs that are not part of any current quality report card and should be measured.

  • The comprehensiveness of services provided by family physicians that is associated with lower Medicare costs and hospitalizations
  • Increased physician-patient continuity that is associated with lower costs and fewer complications of common chronic conditions, fewer hospitalizations, and lower overall mortality
  • Smaller primary care practice size that is associated with reduced hospitalizations from preventable conditions
  • The rate of generic prescription writing that is associated with lower costs.
  • Others could be increased time for office visits for complex patients, 24/7 access to local clinic professionals, and careful selection of referral specialists.

Some of these could be measured off of claims data: comprehensiveness of CPT codes and generic prescriptions written. Others would be annual infrastructure assessments: practice size and whether the practice has 24/7 access capacity.

These would be much more meaningful and much more on point of what family physicians do that actually lower costs and improve quality than any of the past or currently proposed metrics (Common Core Primary Care set).

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4 Responses to Ways to Improve Family Physician Quality – Measure Other Aspects of Primary Care Capacity Associated With Better Outcomes

  1. Pat Jonas on July 9, 2017 at 10:39 pm

    This is weak and superficial. Your heart, fortunately, isn’t into these phony measures.
    Quality measures such as these might be more meaningful: Did the patient get to see their daughter play in the soccer game. Could the patient breathe well enough to satisfactorily pray with their dying mother, etc. Real people warrant real quality. It’s not about the statin. It’s not about the A1c. It’s Family Medicine.

    • Richard Young MD on July 10, 2017 at 9:25 pm

      You’re both right, this is a list of measures we threw out into the public arena to at least try to propose a halfway reasonable middle ground. I will get to the solution soon, or you could skip to the end of the movie and just read the article we wrote.

      • R Watkins on July 14, 2017 at 12:34 pm

        Read your article when it came out, but had the same problem with it. That is, it seems like you’re saying: even though there’s no evidence that “quality measure” have any beneficial effects and there is much evidence that linking them to pay has many negative effects, our number one responsibility as physicians is to keep the insurers happy so let’s try to come up with some slightly less onerous measures.

        Why do we find it so impossible just to say NO, quality measures are bad for physicians, bad for patients, and bad for American medical care?

        Well, I can dream.

        Thanks.

  2. R Watkins on July 10, 2017 at 10:10 am

    “the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or practices whether physicians like it or not, or whether it’s really useful and fair or not”

    Very much appreciate your blog and the thought and work you have put into it, but strongly disagree with the above statement.

    This is exactly the sort of weak, go-along-to-get-along type of thinking that has gotten us into the mess we find ourselves in. If something is as wrong in every regard as P4P, we are obligated to oppose it 100%, not to try to fluff it around the edges. Or the result will be more of the same.

    Thanks again for your blog.

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