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"The Health Care Quality and Cost Council: Great Promise, but...." by Dr. B. Dale Magee

Embedded in the Health Care Reform Law is a provision for a health care quality and cost council, charged with establishing "health care quality improvement and cost containment goals…designed to promote high-quality, safe, effective, timely, efficient, equitable and patient-centered health care."

This is a serious responsibility. Indeed, the Boston Globe, in a May 15 editorial, called the council's work "Item #2 on healthcare agenda." The council has great promise, but unfortunately has languished to date, a fact noted by the Globe editorial: "Unlike the connector, the council has not made much of an impact."

One of the major charges of the Council (full disclosure: I am a member) is to develop a means of measurement for health care cost and quality that will inform the public, most likely through a website. Most agree that the average citizen is not likely to log on to this site before dialing 911 or before calling their doctor and telling them to call off the operation. Mostly, this will be used by the various providers themselves to see how they are doing.

In the end, the most important thing to come out of this effort will be enhancing the ability of ALL of those who provide health care to improve both their cost and quality profiles.

As it stands now this is not likely to happen. The Council is underfunded and cannot invent its own means of measurement.
As of this writing, the funding for the Council still remains undetermined.

Another major concern I have is that practicing physicians are underrepresented on the Council. As a result, the council is most likely to adopt measures that are already being tried by the various plans in the state. This is a huge concern, because few in the medical profession feel that these measures, as presently constructed, are accurate enough to use. Indeed, the Medical Society last year passed a resolution that "opposes implementation of physician tiering mechanisms as cost containment or quality assurance programs, unless and until the underlying measurements and methodology are validated."

Billing data (on which even the medical quality measures are based) often attributes patients to the wrong doctor or leads to recommendations for tests that are not appropriate for the patient. Physicians have known this for years, but the health plans see no good, viable alternatives and persist on using these approaches that physicians think are too often questionable. Medical Society members have seen current programs place individual physicians in different tiers by different health plans, judging them on administrative data that is three years old, and evaluating them on procedures that are not within their medical specialty.

The Council must reach out to practitioners and learn what makes sense to physicians. Measures of evaluation need to relate to the process of health care delivery to patients. Before turning them into report cards, the measures should be made available in a usable format for physicians to improve the care of patients, and correct the errors that are so prevalent in the data. Then, and only then, can both parties respect the resulting reports as reflecting their actual performance.

B. Dale Magee, M.D., M.S., President, Massachusetts Medical Society

This program aired on May 24, 2007. The audio for this program is not available.

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