The Ongoing Quest for Quality

he search for quality continues.

In a report released just last week (see this week's "Pelzman's Picks"), the Government Accountability Office (GAO) revealed that the committee that sets relative value units (RVUs), which are a big part of determining the level of pay for physicians in this country, has been working with terrible data, and that there may be conflicts of interest afoot.

What a surprise.

Apparently this committee sends out surveys every year to physicians to help set the value level of effort that goes into all of the encounters involved in healthcare, from major surgeries down to minor office visits. This is part of the data that go into setting the RVU, which pegs what we do in our practice against a payment standard.

Just think of it, a bunch of surveys get mailed out, a tiny percentage comes back, gets reviewed by some committee, and this sets what we all get paid.

This is frustrating enough, and for those of us at the "low end" of the scale (i.e., not procedure-based specialties) who are practicing evaluation and management in the office, we have long felt the system devalues the work we do, encourages procedure-based care, and perhaps subconsciously guides trainees towards these more lucrative fields.

As we've seen, much of the move to migrate care into patient-centered medical homes and accountable care organizations hinges on an accurate assessment of quality. We are moving toward a system of quality-based reimbursement, so everything from length of stay and inpatient complications to completeness of healthcare maintenance and counseling will count toward the pay that healthcare providers receive in the future.

If the powers that be are unable to accurately collect information on the relative value of our care under the current system, where you would think we have a selfish interest in returning surveys that show how much work goes into doing what we do, how precise do we think the government measurement of true quality will end up being?

And what is quality? What does it mean to provide quality care? Is this something we can truly measure?

But even more, it makes me worry about the government's ability to accurately collect and assess data -- to collect enough information to really determine whether we are providing quality care to our patients.