Summary
Somebody really smart once said, "Sleep, riches and health to be truly enjoyed must be interrupted." However flawed P4P, EBM, TQM, critical pathways, centers of excellence, and outcomes measurement are, they at least attempt to define QUALITY. The argument rages and usually ignores the most obvious critic - the patient. We discussed this at length 20 years ago, and the best definition of quality was defined by whether the patient was returned to their state of health prior to onset of health attack. If the patient was surveyed about quality after being returned to their previous state of health then quality = good. If the patient was not returned to their previous state of health = quality bad - however egregious to the inspired or offending physician using the latest and greatest technology. Weighting patient sentiment is essential to accurately evaluating outcomes. The rub is it requires treating the whole patient and not just delving a procedure.
Analysis
Consumer feedback is a great idea. There is no question that expensive providers practicing outside of the "peergroup" raise the same type of payor attention that bacterial counts do to physicians. We know that physicians shown to be practicing outside of their peergroup, return to the center line. We also know that pysicians practice defensive medicine.
Fee for service medicine is the driver of our "disease care" and not "healthcare" system inflation, and performance measurement ineffectiveness. The data overwhelmingly tells us, how we pay doctors affects how they practice medicine. Capitalism is good. Tthere is no better voice for QUALITY in healthcare than the patient. Everyone would be wise to heavily weight how the patient feels about their care. Whether by placebo or a spiritual intervention of sorts, how a patient feels during their treatment and after their recovery is real. It is a great idea to post patient feedback, and one that plan managers and physicians will use to win or lose patient customers.
