Quality Without Qualification

It seems you can’t open a journal or attend a conference in recent years without encountering lip-service about the importance of quality in healthcare. Other nebulous buzzwords are mixed in for variety, whether or not as part of newer platitudes like “transitioning from volume to value.”

Much as in the business (and political) spheres which spawned them, this incarnation of Newspeak is utilized by a lot of folks who want to sound relevant and clued-in as to what’s coming down the pike. With it, you can really kill a lot of podium-time (or real estate on written pages) without actually having to say anything substantive, and nobody can really argue with your words - after all, a lot of very important people are using them, and who could disagree that value, quality, efficiency, etc. are worthy pursuits?

Not surprisingly, you don’t find too many folks rapt with attention when confronted with such talk. Call me crazy, but I think it’s because maybe we already have a pretty good handle on what quality and those other noble concepts are. Most mentally-competent adults do, even without carrying the equivalent of a small medical library around in their long-term memories. We’ve experienced quality (and lack thereof) in plenty of venues including healthcare, both firsthand and vicariously.

So maybe the idea is that, without being reminded and/or watchdogged to provide quality professional service, a lot of healthcare folks will lazily or maliciously perform at a lower level. Mind you, I can’t say I recall any med school classmates eagerly rubbing their hands together in anticipation of the day they could be turned loose upon the patient population to practice crummy medicine.

Yep, believe it or not, we tend to take pride in doing as good a job as we can. Go figure; it took quite a bit to get into this field, so maybe we consider the work important enough to give it our best. Or maybe we’ve heard one too many horror stories about what can happen to our credentials and very livelihood if we slack off or are simply unlucky.

I’m going to go out on a limb, here, and suggest that the architects of this ongoing campaign for quality, added-value, or whatever other business-school jargon is in fashion know these things. They don’t really expect that their talk of quality is going to turn our heads around, or make healthcare into any more of a well-oiled machine (as if!) than it currently is. More than a few of them have come up with a way to pocket a few dollars (or votes) for themselves by beating this particular drum; it might not be overly cynical to suggest that this is, in fact, their primary motivation.

“But wait!” an optimist might exclaim. “Maybe they really believe in this. After all, we keep hearing about pay-for-performance stuff, especially in PPACA. We’re going to be rewarded for doing a good job; shouldn’t we be happy about that?”

Color me a pessimist, but I don’t think that there’s any grand plan to start showering us with extra goodies for doing the good job we’ve already been trying to do. There just aren’t any to give out, especially with so much of our overburdened system’s resources getting siphoned by folks not actually producing or delivering healthcare (such as those mentioned above). Rather, I think “quality” stands to be just another handy pretext to further lower reimbursements and assign penalties to claw back previous payments.

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For instance, if the goal is to reduce physician payments by another 20 percent, set the quality-bar at a level where only 80 percent of current healthcare will henceforth pass muster. Even if actual measurement of quality isn’t so much taking place, as is a mix of the proper paperwork, red-tape navigation and kissing up to the right regulators.

Pushing back against this stuff, individually, ranges from difficult to impossible. Often, it means fighting City Hall, and even if this weren’t the case, one stands to appear obstinate and unreasonable by simply calling quality-improvement measures bunk and refusing to participate. I have heard some encouraging things about using (shudder) evidence-based medicine to prove that certain initiatives do not, in fact, improve quality, or at least cost far more than they save. In essence, giving the quality industry a taste of its own medicine. Hopefully we’ll see more of this in the future.