Saturday, October 07, 2006

More criticism of the Institute of Medicine

A recent commenter on ER crowding and the IOM said----

“The IOM is basically a government agency whose aim seems to be to find fault with and criticize health care professionals without having to find the means to properly fund their mandates. They make headlines and take the public's attention away from the real issues of healthcare economics. Our various professional organizations are afraid to refute their findings because we don't want to sound like we're whining. Yet we had better do so or all we're going to see is continued finger pointing and no real change.” I certainly agree with that. If the professional organizations won’t do it maybe the bloggers will!

As long as we’re picking on the IOM, NEJM recently reported on the IOM’s assessment of pay for performance. As we know, P4P is merely “playing for the test” and has little if any impact on real quality. Not to my surprise I found the IOM recommendations a little naïve. You can listen to the interview here or access a free transcript here.

The interview raises a few questions. They want to expand the P4P concept to reward not just quality, but also efficiency and “patient centered” care. Well, we already have a very powerful negative efficiency incentive----that hidden provider tax known as DRG. We also began a massive experiment in efficiency incentives almost a decade ago known as managed care.

And what is meant by “patient centered care”? It sounds great, but I thought all medical care was basically patient centered. It must mean something extra special----so what is it, exactly? Those folks at the IOM must be mighty smart if they can measure something as nebulous and subjective as patient centeredness. For phase two of their initiative they might consider measuring compassion, honesty, and empathy.

Although those are pretty lofty goals they’re going to start with the basics: reward providers “just for reporting data, at least initially.”

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