IOM on Health System Metrics

Regular readers know we have a jaundiced view of the proliferation of “quality” measurements.  Providers suffer from overload, attention may be directed to unimportant areas, and there is a substantial administrative cost in gathering, analyzing and reporting the data.  The Institute of Medicine has attempted to address the problem in a new report, Vita Signs:  Core Metrics from Health and Health Care Progress.   The report is summarized in a Journal of the American Medical Association article.  (JAMA Article)   The IOM committee responsible for the report was charged with identifying the most useful measures and recommending how they be implemented and maintained over time.  They came up 15 “core metrics”, including life expectancy, self-reported health status, obesity, addictive behavior, unintended pregnancy, community health profile–environmental and social factors like parks, education, housing, receipt of preventive services, care access, patient safety, evidence-based care use, care related to patient preferences and goals, spending burden, individual engagement and community engagement.  Two quick observations; 15 measures is a lot and these are mostly mush that would require bushels of more specific data points to be gathered.  While the IOM committee purported to be concerned about measure fatigue, utility and burden, its report seems to require more of the same–a whole bunch of groups creating a whole bunch of new measures, also probably not well-tested for actual impact on health status and outcomes.  The notion of evidence-based medicine alone has led to a proliferation of hundreds of guidelines, and then we get “quality” reporting to ascertain whether the guidelines are being adhered to, at least before they change because new research shows that the old standards of care were wrong.  This has happened repeatedly in large disease categories, like hypertension, lipid management and diabetes.  And one of the biggest problems from all this quality management is that many providers are simply giving up–taking the reimbursement hit and moving on, doing the best they can for their patients using their professional judgment and experience.  One of the best things we could do to advance “quality” would be to de-couple it from reimbursement.  Lets do a little contrarian thinking here and ask ourselves whether the whole value-based purchasing notion really makes any sense and has any likelihood of accomplishing its purported goals at a reasonable price.