Down the Rabbit Hole of “Quality” We Go

Oy: The Obama administration on Monday announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity. Holy crap: they’re really doing it. Or trying to do it. Who the hell knows what they’re trying to do? Not “them”, that’s for sure. The United States government via the Department of Health and Human Services is going to start trying to pay for “Quality of Care” without ever defining what that means! Doctors practice medicine, an art and a skill that sometimes involves procedures and sometimes involves cognitive services. That last one means “thinking.” When you do a procedure, usually when you are done you have something to show for it; generally a wound or a specimen. When all you do is sit and think — which includes listening to and talking with patients — how does anyone else know what you’ve really done? One way is if you write down what you were thinking about, thus producing what we call the “medical record.” Actually, I’d be okay with this if only they looked at the right part of the record: the assessment. Instead, thanks to EMRs, the medical record has devolved into a useless mass of cut and pasted, bullet-pointed lists of history and exam items that ends up useful only to billing clerks and malpractice attorneys. At this point it’s often more of a hindrance than a help to anyone actuall...
Source: Musings of a Dinosaur - Category: Primary Care Authors: Tags: Medical Source Type: blogs