Your Voice Frustrations from quality metrics remain intact

June 10, 2016

Quality metrics, MOC and physician income are the hot topics readers are talking about in this issue of Your Voice.

Frustrations from quality metrics remain intact

"Quality Metrics: Helping or hurting medicine (March 10, 2016)â€Â sung the praises of major government programs, HHS, CMS, ACA, MACRA, and MIPS. 

We all know the story on healthcare being crushed by acronyms over the last century, and your Medical Economics board member Dr. Joseph Scherger, leads us all down the government rabbit hole, â€Å“you’ve got to basically tell yourself that this (reliance on metrics) is probably a good thing overall, but when it’s applied on the ground it can be frustrating.â€Â

Reading Dr. Scherger̢۪s article raises some serious doubts in my mind that if he has ever run a solo private practice where individual care rules the day and always has. He sounds more like an administrator/bureaucrat working for a big organization in the government or an insurance company, detached from the ground reality, while inventing the population medicine farce.

Quality metrics have never been proven to represent any measurements of value. So called, ‘value based care’ and ‘population medicine’ are dangerous schemes that will ration care based on some party’s criteria that they will profit from. 

Physician medical care of an individual patient cannot be judged by and equation, third-party, or Government department, but only by the individual patient involved. He or she must also pay directly for the care so that it fits their moral, ethical, and budget criteria for their own private value system not any other entities. 

Perhaps Medical Economics can return to days of previous years where real debates are held and all sides presented? This gives the physician reader respect and the opportunity to formulate, or even change, a position based on detailed information, dogma, research and opinions from all sides. 

 

Craig M. Wax, DO

Mullica Hill, New Jersey

 

Next: My advice to ABMS on certification

 

My advice to ABMS on certification

One of the biggest lessons that I got after reading â€Å“Maintenance of certification: inside the physician revoltâ€Â (March 25, 2016), is how even within the ‘house of medicine’ physicians have to remain vigilant. 

Besides insurance companies and malpractice lawyers, there are many forces—such as the ABSM—each with their own special ambitions and desires to extend their influence over doctors.

Medicine enters into just about every segment of our lives. And in our capitalistic culture there are always those industries with the capability and strength to look for new area of profit-pharmaceutical companies and makers of medical instruments immediately come to mind.

The ABMS would do well to do away with their punitive approach and provide self-assessment tests with answer booklets for doctors in their various specialties.

Initial certification should be as untouchable as a Bachelor of Arts or PhD degree.

 

Edward Volpintesta MD

Bethel, Connecticut

 

Next: Physician Report still doesn't make me feel better about income outlook

 

Physician Report still doesn't make me feel better about income outlook

Physician Report still doesn't make me

feel better about income outlook

While I realize that you're trying to provide an optimistic spin on the Annual Physician Report, several weak spots jump out at me.  

In an attempt to proffer an apparent improvement in practice finances, the Better-Same-Worse categories beg for clarification. As a hospice doc, if I have a guy writhing in pain (10 out of 10) and reduce it to 8 out of 10, that would be ‘better’, but seriously deficient in reaching our goals. 

By the same token, if things really sucked financially last year and they haven¹t improved, that would be a ho-hum, ‘about the same’, but I’d still be stressed and struggling. Get my drift?
I see 1/3 of docs in the ‘worse’ category year after year as the most telling indicator of our nightmare. 

This is particularly worrisome given that most of your respondents were in small, private primary care environments. 

Furthermore, I see family docs get a 1.5% income boost. But, wait. With a 0.9% inflation rate last year, that is only a 0.6% increase! My local taxes are providing a 3-10% boost in pay for our local government employees!

My main point is that if we̢۪re treading water, that data doesn̢۪t reassure me that we̢۪re getting rescued and still not going to drown!

 

James B. Vogus, M.D., FAAFP, HMDC

Redding, California

 

Next: MOC debate needs to remain balanced

 

MOC debate needs to remain balanced

I don’t usually write to the editor, but after glancing at your most recent Medical Economics online edition, and seeing the headline â€Å“MOC pushed me out of medicine (April 26, 2016),â€Â I thought, something is not right here.  Doth the lady protest too much?

MOC has positive and negative objectives—some well executed and some poorly executed.  I grow suspicious of a magazine overly dedicated to one aspect of a debate. Particularly when it is the easy, popular, emotion tugging complaint anyone can bash MOC.  Did I miss an issue defending whatever aspects of MOC are defensible? 

I prepared and passed MOC—some aspect I did not like other aspects I enjoyed. I would like to hear from the ABIM and other governing bodies their defense of MOC.  Again, if this was covered, please point me.

 

Gino Freeman, MD

Baltimore, Maryland

 

Next: Forced to retire amidst all the troubles in medicine

 

Forced to retire amidst all the troubles in medicine

I just retired my solo practice of IM after 40+ years in the Washington D.C.area.

I (recently) turned 70, but felt I had more years to give my practice. I just could not stand it anymore, (even though) I can afford to retire. 

It is absolutely stunning that we are being replaced by non- physicians and big drug store chains. Oh well, there are too many issues to discuss. I am looking forward to improving my golf handicap.

 

Nancy Falk, MD

Chevy Chase, Maryland