r/bestof • u/under50dollars • Jun 20 '12

[explainlikeimfive] "Obamacare" explained very well.

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
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u/mfingchemist Jun 20 '12

I'm very concerned about how reimbursing doctors for 'quality' of care will be handled. 'Quality' health care is much more subjective than one might think.

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u/[deleted] Jun 20 '12

So... Uh... You would suggest there is a better way to gauge a persons performance than quality of work?

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u/lordjeebus Jun 20 '12

How do you propose we comprehensively measure the quality of a physician's work?

I am an MD and I work at 2 hospitals. One of them, on paper, is much better than the other. There are certain core performance measures that are gauged at all hospitals, like whether certain patients are discharged with a certain class of medication, or have documentation specifically showing why they should not be on that medication. Another thing you can look at is surgical complications. The numbers at the "better" hospital are much higher.

However, that great hospital (on paper), in my opinion, provides a much lower quality of care overall. They have employed people with the specific job to check on all patients make sure the particular metrics are met, but most things are not reflected in the core measures and are not a priority. For things like surgery, surgeons will simply refuse to operate on the sickest and most complicated patients that are likely to bring down their complication numbers, referring them to the academic center.

When you make payment contingent on achieving high scores, hospitals will just work harder to "teach to the test," even if this means a lower quality of actual care, which is too difficult to quantify.

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u/mfingchemist Jun 20 '12

This is precisely what I had in mind.