In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or practices whether physicians like it or not, or whether it’s really useful and fair or not.
Other aspects of primary care are associated with better outcomes or lower costs that are not part of any current quality report card and should be measured.
- The comprehensiveness of services provided by family physicians that is associated with lower Medicare costs and hospitalizations
- Increased physician-patient continuity that is associated with lower costs and fewer complications of common chronic conditions, fewer hospitalizations, and lower overall mortality
- Smaller primary care practice size that is associated with reduced hospitalizations from preventable conditions
- The rate of generic prescription writing that is associated with lower costs.
- Others could be increased time for office visits for complex patients, 24/7 access to local clinic professionals, and careful selection of referral specialists.
Some of these could be measured off of claims data: comprehensiveness of CPT codes and generic prescriptions written. Others would be annual infrastructure assessments: practice size and whether the practice has 24/7 access capacity.
These would be much more meaningful and much more on point of what family physicians do that actually lower costs and improve quality than any of the past or currently proposed metrics (Common Core Primary Care set).
