I think most doctors can agree that quality metrics do allow for better medicine overall. But is this going to be at the expense of healthy patient-physician relationships? The doctor above questioned whether she wanted to practice the next 30 years getting annoyed with patients who make her scores go down.
When you are the lowest in the group for quality scores, it is a stimulus to try to score higher the next quarter. (Doctors by nature are a competitive bunch.) Does this mean you discharge your poor performing patients? The patients’ backgrounds, education and socioeconomic status can all contribute to why they make the decisions they do regarding testing and treatment. Physicians have no control over this. We can talk a convincing blue streak and still not persuade a patient to have a mammogram.
Should doctors be financially punished for this? Also, an indigent patient may be more apt to over-utilize the emergency department even after extensive education by the staff. This will ultimately cause a lower score. Does that mean doctors shouldn’t take care of indigent patients? My answer is certainly not!
All patients are entitled to high quality healthcare. This includes patients who refuse that care. Socioeconomic status, education level and background issues should have little to do with who we care for and how we provide that care. Physicians should always offer the best they have to give and appreciate each and every patient for who they are.
When it comes to quality scoring, even if you suffer the ding, you are hopefully still making a decent living. If all doctors gave up on the noncompliant patients, that would reflect very poorly on our profession.