They
say that measurement is the first step towards controlling and
improving things, and that “you are what you measure”. Management
dogma has long promoted intensive measurement, tracking and reporting
as the main driver of desired change.
Unfortunately, as
the Common Core debacle has demonstrated, any attempt to apply this
theory to practice will see it quickly erode in the face of two
inconvenient realities. First, critical and relevant aspects of a
situation are often intangible; they simply don't lend
themselves to effective and accurate measurement. Second, no matter
what you're looking at, there are almost always scores of
contributing and/or influential factors, making it almost impossible
to measure, aggregate, and report on them in a meaningful way.
Considering that some of those factors will be several steps removed
from the “main action” and/or intangible, and you've got a clear
recipe for frustration!
Why am I rambling at
you about this business nonsense? Because it's exactly what came to
mind when
I
read that “non-profit news outlet ProPublica [has created a]
never-before-available tool” they're calling an "
Adjusted
Complication Rate." Long story short, they've developed and
launched a scale ranking “Nearly 17,000 doctors performing
low-risk, common elective procedures such as gallbladder removal and
hip replacements... in the new calculation...derived from government
records collected about Medicare patients...” The score looks at
post-operative complications “like infections, clots or sepsis”
and a handful of risk factors such as “patients' ages, the quality
of the hospital where the surgery took place, and other factors.”
The goal is
straightforward: provide consumers a tool through which to compare
the quality of potential surgeons before scheduling a procedure, and
create a highly public venue through which to shame, scare, or (more
euphemistically) motivate both doctors and the hospitals for which
they work to step up their games, sharpen their skills, and identify
and remove roadblocks to top-notch patient care. As a bonus,
proponents suggest that these changes will significantly reduce the
cost of readmissions related to surgical complications. Considering
that such readmissions for Medicare patients cost “taxpayers $645
million” between 2009 and 2013, this is no small benefit.
ProPublica's
intentions are clearly noble, and they should be applauded for doing
something. After all, you never get anywhere if you don't at
least try! That said, I can't help but cringe at what looks
alarmingly like the early stages of a repeat of the Common Core
disaster in the making. They're right to note that not all doctors or
hospitals are created or perform equally. Certainly those doing well
should be rewarded, and those at the bottom of the barrel strongly
motivated to improve.
But the inconvenient
truth is that people are bio-individual,
both physically and in terms of
their physical, social and familial support systems. For
example, as an NTP I can tell you that most people are walking
around with all kinds of undiagnosed and unrecognized health issues
that are directly relevant to their ability to heal and their
likelihood of readmission. My sister the nurse can testify to the
kinds of disastrous individuals and relationships patients often rely
on for their post-procedure care. These things are not, and cannot
consistently or realistically be, accounted for on this index. As a
result, just like teachers, doctors will be penalized for things
outside their control without recourse to explain or defend
themselves. Doctors battling to revamp struggling hospitals, or
serving the lowest-income, most at-risk patients will suffer the most
in this respect, punished for their faith, elbow grease, and big
hearts.
Many doctors will
respond by taking the only protective course available to them:
refusing to see or work with any patients who don't present as
excellent candidates for a quick, clean recovery. Dealing with a
messy family situation? Obese? Smoker? Low-income? Cantankerous or
absent-minded? Watch how fast you get turned down and punted over to
the waiting list for one of the handful of (low ranked) doctors still
willing to take you! As it stands, this well-intentioned ranking will
most likely have the unintended (if predictable) effect of making
losers out of neediest, least-ideal, and highest-risk among the us
and those who stubbornly continue to serve them.
I can't help but be
deeply saddened to see this kind of thing happening. We need real
answers; real initiatives that get at the heart of the problem (like
the
increasing loss of non-profit hospitals), rather than relying on
false metrics and sideways pressure.
