Accountability: If You Can’t Measure It…

Let’s get even more pragmatic about our values and talk about accountability.

It is a business truism that if you can’t measure it, you can’t manage it.  Our healthcare system is incredibly adept at measuring revenue, procedures performed, and patients moved out the door.  In our current system, physicians and facilities get tangible rewards for managing these measures efficiently.  However, research such as the Dartmouth Atlas illustrates that more of these things—payments, procedures, and patient throughput—aren’t yielding better health outcomes.

We need to focus on measuring quality and holding providers accountable for it.  We need to redefine efficiency as using our resources to get the best health outcomes.

As the largest payer in healthcare, the Centers for Medicare and Medicaid Services (CMS) has made substantial progress toward building accountability into the system.  Nearly all hospitals that provide services to Medicare patients report on quality measures such as steps to avoid infection, mortality rates for certain surgeries, and quality of patient experience.   However, there is still a long way to go towards accountability throughout healthcare. When CMS gave physicians an opportunity to report their use of good practices in caring for Medicare patients and offered a financial incentive for that reporting, the initial response rate was below twenty percent.  That level of accountability is not enough.

Health care reform must support the efforts underway at CMS and among private payers to measure the use of good practices, the rates of positive health outcomes such as diabetes or blood pressure under control, and the level of patient satisfaction with communication and controlling pain.  We must achieve a high level of measurement so that physicians and providers can manage their quality and be held accountable for it.  Only then can we get to the point where doing health care well is as rewarding as simply doing a lot of it.