Doctor report cards won't measure quality of care

Washington's attempts to micro-manage education quality and outcomes have been described by parents, educators and even lawmakers as punitive, broken and too prescriptive and have resulted in teachers "teaching to the test" in an attempt to generate good test scores and the resultant financial support from the federal government.

Kentucky has added its name to a list of states applying for a waiver to exclude them from the Bush-era No Child Left Behind legislative mandates created during the past decade.

But as big government appears poised to back away from this failed attempt to control the very definition of high-quality teaching, Washington stands ready to force another set of arbitrary and unproven standards on the nation's health care providers.

This program will tie physician reimbursement for the care of Medicare patients to scores derived from a standardized check-list that presumes to accurately measure the quality of provider performance and the doctor-patient relationship.

The Physician Quality Reporting Initiative ties payment for physician care of seniors to a report card. Using a check-list, physicians will be rated on their performance by non-physician government employees who will use this data to separate good providers from bad.

By tying reimbursement to this "quality measurement," physicians (as was the case with teachers) will be forced to "treat to the test" to ensure medical practices will be paid appropriately for the care of their patients.

And just as it was for the students who were the ultimate casualties in No Child Left Behind, it will be the patients whose care will suffer.

Physicians and their support staff will be forced to spend more time filling out government mandated paperwork and less time face-to-face with their patients. The program will require the purchase of expensive reporting technology by practitioners, increase practice overhead costs, increase the need for additional staff for no other purpose than to comply with federal reporting regulations and, in the process, do nothing whatsoever to improve patient care.

Failure to provide Medicare with the requested data will ultimately result in reductions in reimbursements for patient care — this, at a time when physician reimbursements are already "under water" as compared with the current cost of care delivery.

The idea that a check-list of dos, don'ts and test scores will result in an upgrade of care delivery is reminiscent of the government supposition that it alone could legislate the teacher-student relationship in the interest of improving education outcomes. It didn't work in education, and it won't work in health care.

Simultaneously, Congress and Medicare have initiated programs designed to force physicians into e-prescribing (electronic prescription writing) and the use of electronic medical records — neither of which has been proven to improve safety, efficiency or quality — but both of which are being forced on our nation's providers by reducing payments to those doctors who cannot or will not comply, whether due to financial constraints or legitimate philosophical differences with Washington policy.

The architects of these programs and of health care reform itself did not ask patients what they believe are the key elements of a high-quality doctor-patient relationship, nor was their input or opinion sought on whether they want their physician financially penalized for non-compliance with these mandates. Patients remain savvy enough to recognize good care when they see it and will continue to choose their health care providers without any assistance from government bureaucrats and their resource-draining policies.

And legislators certainly did not ask the opinions of primary-care providers, any of whom could easily describe how increasing government regulations, mandating the purchase and use of expensive technology, and the threat of stiff financial penalties will not only detract from the care of patients but, worse yet, will drive already overwhelmed providers out of practice altogether.

In a few years, maybe sooner, we will be reading about physicians and state governments applying for waivers to excuse them from the onerous, burdensome and ineffective mandates contained in what has ironically been referred to as health care reform.

Perhaps this program should be referred to as "No Patient Left Behind."