and diabetes management. One quarter was based on the"population health" metric of a certain percentage of eligible patients undergoing Medicare annual wellness visits. The remaining quarter was based on a"patient experience" metric, in which patients were asked about the likelihood of recommending their primary care doctor to others.
In the past, I usually did not qualify for the quality bonus. I received high patient experience ratings, but enough of my Medicare patients weren't aware of or interested in having a wellness visit, and I struggled to show that patients with white coat hypertension who had high blood pressure readings recorded in the office were under good control at home, where it matters.
My new practice uses a similar set of metrics that, if achieved, also result in an annual quality bonus. In addition to the adult metrics, they have focused on childhood lead screening. After learning that some parents were not bringing their children to the laboratory, they encouraged nurses to instead do a capillary draw at the office visit.
In theory, it's not a bad idea to provide financial incentives for doctors to keep their patients satisfied and provide preventive care and treatment that is consistent with best practice standards. But, I have problems with the way quality measurement is typically practiced. First, the metrics are not always evidence-based. For example, thefound insufficient evidence that testing lead levels in asymptomatic children improves health outcomes.
for its near-exclusive focus on"measuring healthcare processes and intermediate outcomes, not health". Aside from patient satisfaction, he noted that none of the metrics that were then used by Medicare's Merit-based Incentive Payment System assessed achievement of the pillars of primary care: first-contact care, continuity, comprehensiveness, and coordination of care.
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