How perverse incentives are ruining healthcare
Programs like PQRS and Meaningful Use are delivering inferior care, keeping patients in the dark, and have driven me out of practice.
For seven years, I practiced at a New Hampshire-based internal medicine practice affiliated with a local hospital. Before that, I was in solo practice in Maine. Today, I am no longer a practicing physician.
Dissatisfaction and burnout among primary care providers-a function of larger and sicker patient panels, inadequate appointment times, more burdensome and tedious administrative tasks, and poor compensation-have been well documented. The rewards of the doctor patient relationship and the intellectual stimulation of clinical problem-solving were enough to keep some of us in the primary care trenches. But it was a close call.
With the introduction of CMS's unethical incentive and penalty programs, most notably the Physician Quality Reporting System (PQRS) and Meaningful Use (MU), an unpleasant practice environment was now an unacceptable one for me.
PQRS
PQRS is a deeply flawed program, as the following examples involving primary care benchmarks illustrate.
Under PQRS guidelines, it is assumed that progressive lowering of average blood glucose in Type 2 Diabetes Mellitus (Type II DM) results in progressive improvement in long-term outcomes. Average blood glucose over a three-month time period is measured by A1C percentage. People without diabetes have A1C values in the 4.5% to 6% range. One PQRS benchmark measures the percentage of a physician’s diabetes patients whose A1C values are below 7.0%, thereby incentivizing aggressive use of medication in this population.
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