This is important to you. Trust me.
If you’re young at heart, it matters because it’s your tax dollars this April. If you’re wiser in years, it directly affects your health and the system you’ve been pumping money into for decades. This is the same medical system that you thought would take care of you later in life. Again, this is about your money and your health, so read on.
It has become perhaps the silliest four letters in healthcare: PQRS. It stands for Physician Quality Reporting System. It’s another this and another that created by the Centers for Medicare and Medicaid Services (CMS). After you read this, you’ll be like me, scratching your head trying to understand why anyone thinks our healthcare system is better under CMS’s leadership.
CMS has setup a thing called PQRS, so physicians across the country can submit data informing the government how well they are practicing medicine. I wish that I could ease your understanding of this acronym by just referring to it as “quality data,” but it no more represents quality than a coin flip. In fact, statistically, a coin flip is probably better. PQRS is like the fisherman explaining to the rancher the type of fish that he caught. Actually, it’s nothing like that. It’s more like the fisherman’s boat explaining to the rancher’s cow the very same thing. Basically, the rancher sums it up: “Ain’t nobody have a clue what’s really going on here.”
I’m a cardiologist. I’ve written one of the most transparent books about the U.S. healthcare system that you will ever read. Yet, if you believe the news, you will assume my entire medical speciality is shady and full of morally suspect physicians. Let me tell you WHY.
In the last month, two articles surfaced in the lay press, one published by The New York Times and the other by U.S. News & World Report. Like the majority of medical news that I’ve seen originate from these sources over the last few years, the articles provide no meaningful contribution to advancing quality standards in medicine or improving patient care. They are written by medical outsiders and fraught with errors. But, to their defense, the authors have been tasked with the impracticable job of interpreting a data dump of poorly understood numbers released to the general public by the Centers for Medicare and Medicaid Services (CMS).
This week, the Department of Health and Human Services (HHS) announced an ambitious goal to have 85% of payments made to doctors linked to clinical quality measures within the next two years. HHS believes that incentives should be weighted almost entirely toward quality of care instead of volume of care. I guess if you’re a patient, you could ask yourself the following question: are you currently more frustrated with (1) your quality of healthcare, or (2) your inability to get an appointment in a timely manner?
The truth is that both are equally important. And, since the latter problem will only get worse after eliminating incentives for volume, HHS is essentially betting the future of your healthcare on its own ability to assess and manage quality. Oh, gosh, I just read that sentence again, and nearly collapsed thinking about it.
Meaningful. Having a serious, important, or useful quality.
You know this word because you want it to define your life. Nearly all of us, at some point, will seek a more meaningful existence. Most wish our jobs were that way too.
This isn’t a debate about vaccines.
The fight here has nothing to do with that. For the record, I strongly support the concept of vaccination. Public health is better in the 21st Century because of it. Measles? Mumps? Oh, I can find you in the United States, but we aren’t living our lives every day petrified of an outbreak. Smallpox? Polio? Where did you go? Not here, that’s for sure. And, what if you had lived in West Africa in mid-2014? A proven vaccine for Ebola would have been a godsend.