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Quality Metrics: Outcomes Versus Process

First let me introduce myself. My name is Erica Brode, and I am the new ITUP health policy intern. I am currently pursuing my MPH in Health Policy and Management at UC Berkeley while taking a year off between my third and fourth years of medical school at UC San Francisco. It is a great time for health policy, and I am excited to have the opportunity to share my thoughts on topics as I learn about them.

One of the first areas that has caught my interest is the concept of quality metrics. In the third year of medical school, we had a two-week tutorial on health policy during which we engaged in a discussion on quality metrics. From the Coronary Artery Bypass Graft (CABG) studies in New York, we have learned that, yes, outcome reporting does increase quality improvement activities in hospitals and in some cases outcome reporting decreases overall mortality rates.

However, what was even more interesting were the unintended consequences reported in this data. In many instances, the sickest cardiac patients were selectively referred to hospitals out-of-state. They were not only less likely to receive CABG surgery, but also percutaneous coronary intervention (a more common and less invasive treatment) than patients in Michigan, where there was no public reporting.

Although physicians may like to think they are above incentives, it is human nature to respond to pressures – peer, collegial, financial, or otherwise. Does it make sense to give physicians the incentive to risk adjust their patient populations and penalize those providers that treat the highest risk patients?