The Health Care Blog

Physician Quality Report Cards, Part II

By KENT BOTTLES, MD

I am frankly surprised by the number of comments, emails, and telephone calls I have received about my doctor report card blog post. Some were charged with emotion and even anger. The number and tone of the responses indicate that Dr. Danielle Ofri and I hit a nerve that resonates differently with different audiences, and we should all try to better understand the several sides to this important, complex, and relevant issue.

In this post, I would like to explore how we can equip physicians with the humility, courage, and existential strength needed to want to receive the kind of timely, blunt feedback on performance that is necessary for continuous improvement of clinical care. There are models in professional football, innovative teacher training programs, and public school teacher report card initiatives that might inform us. I would also like to revisit my interest in replacing the current pessimistic model of error and failure with a more optimistic model. While we are all too familiar with the shame and embarrassment associated with being told we are wrong, an optimistic model of error and failure guides us to being more receptive to feedback because the focus is not on us, but rather on the “other” that needs to be taught or cared for. In an optimistic model of error, Kathryn Schulz believes we can respond to feedback about failure with bafflement, fascination, amusement, excitement, curiosity and delight.

Why is it so hard for us to admit error and receive blunt feedback? Why is it so important for all of us to always be right? Chris Argyris wrote about why it is difficult for the successful to learn; success really does not teach as much as failure, and when the usually successful fail or need to improve they become defensive. Argyris believes there is a universal tendency for humans to respond to feedback by trying to achieve four goals: stay in control, win and not lose, feel positive, and behave rationally. Harville Hendrix, a marriage therapy expert, believes being wrong is so threatening and unwelcome because of concentric consciousness, having our internal cohesive sense of self disrupted resulting in chaos, and experiencing shame and guilt which is painful. We become rigid in our beliefs and defensive because we do not like feeling insecure.

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Remembering the Tonsillectomy Riots

By MICHAEL MILLENSON

The humble tonsillectomy has been at the center of controversies over practice variation, inappropriate surgery and avoidable harm for decades; indeed, well before the terms to describe those problems were formally articulated.  Now, thanks to the recently unearthed Tonsillectomy Riots of 1906, you can add “patient empowerment” and “informed consent” to that list.

Tablet, an online magazine of Jewish news and culture, rescued the Tonsillectomy Riots from historical obscurity. Piecing together old newspaper accounts in English and Yiddish, the magazine told what happened on New York’s heavily Jewish Lower East Side on a steamy day in June when “50,000 immigrant mothers descended on their local public schools demanding to see their children, having heard that there was a Board of Health-sanctioned child slaughter taking place.”

The article continues:

Greeted by locked doors, the screaming throngs surrounded the schools and began smashing windows and pounding on doors….During this rampage, gangs of immigrants cursed out principals, fought police, and attacked anyone in the street bearing the slightest resemblance to a doctor….Some of them raided vegetable pushcarts for ammunition while others, like one young man who pulled a revolver on a member of the Board of Health, used more serious weapons.

Word had spread among the Jews of the Lower East Side that uptown doctors were coming into downtown public schools and were, as described in the daily Varhayt, “cutting the throats of Jewish children!” After a two-hour assault, the rag-tag army achieved victory: Their kids were released early and alive, proving that no such slaughter had taken place.

From the viewpoint of the befuddled Board of Health, this debacle was likely filed under the heading, “No good deed goes unpunished.” After tonsillitis reportedly kept scores of Jewish students out of school, the principal recommended the children have tonsillectomies. (The idea of a contagious sore throat was apparently not part of folk wisdom at the time.) When mothers complained they couldn’t afford either the doctor’s fee or taking time off to go see one, physicians were asked to perform tonsillectomies at the schools. Days before the riot, doctors had performed 83 tonsillectomies at one elementary school. That’s when the trouble began.

The English-language press reported that the operations all had parental consent. But the Yiddish press told of children sent home with slips of paper their parents couldn’t read using terms they couldn’t understand even when translated.

“All they knew was that when the children returned home from school after their procedures, they did so drooling mouthfuls of blood, barely able to speak,” Tablet related. “Shocked, their parents asked what happened. ‘Doctors cut our throats,’ the children replied.’ Rumors of a wholesale slaughter leapt like wildfire throughout the tenements and shops…and street-corner orators got into the act, screaming about the massacres in the schools, comparing them to the pogroms in Russian-ruled Poland.”

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Health 2.0 Europe: Day One

By Bianca Grogan

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Beyond Meaningful Use: Three Five-Year Trends in the Uses of Patient Health Data and Clinical IT

By DAVID C. KIBBE & BRIAN KLEPPER

Finally, we have a Final Rule on the Medicare and Medicaid EHR incentive programs. The rules and criteria are simpler and more flexible, and the measures easier to compute. But they are still an “all or nothing” proposition for physicians, who will have to meet all of the objectives and measures to receive any incentive payment. Doctors who get three-quarters of the way there won’t receive a dime. And a lot of uncertainty remains about dependent processes that CMS and ONC must quickly put in place, like accreditation of “testing and certifying bodies,” and the testing schemas for certification. All in all, we expect most physicians in small practices to sit on the sidelines until the dust settles, likely in 2012 or 2013.

Nevertheless, while it is good to get Meaningful Use behind us, it may be better still seeing beyond it. After all, the incentive payments for becoming a “meaningful user of certified EHR technology” are merely a small down payment on the savings that could be realized if health care supply, delivery and payment are affected by the changing policy and market environments over the next 5 years. The EHR incentive programs are meant to prime the pump by putting approximately $25 billion, give or take a few billion, into the hands of physicians and hospitals who adopt EHR technology during the 5 years between 2011 and 2016.

During that same time, by comparison, reductions in waste, duplication, and unnecessary procedures might mean savings of $100 billion to Medicare alone,# depending on whose estimate you believe and how effective you think the reforms will be in replacing payment for volume with payment for value. It might be a lot more. Conservative estimates are that 30% of our total national health care expenditure of $2.5 trillion, or over $800 million, is unnecessary and could be eliminated through real reforms. Some authoritative estimates argue that half or more of care costs are unnecessary, so the target jumps to $1.25 trillion a year.

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W(h)ither Insurers?

By PAUL LEVY

The talk around the country among health insurance companies is that their insurance business is dying.

What is happening? First, the consolidations in other industries, resulting in large, multistate corporations, already mean that many companies self insure their employees. Even many local firms have large enough work forces that they can be self-contained risk pools. (One source I found says that in 2008, 89 percent of workers employed in firms with 5000 or more employees were in self-insured plans.) There is no sense compensating insurance companies for actuarial risk when your employee base is that large. Instead, the insurance companies or other firms are hired solely to administer the benefit plans.

For those insurance markets that still exist, the provisions for transparency under the national health care reform law, and the insurance exchanges that will be set up, will result in the commoditization of insurance products. That commoditization will drive down the profit margins that would otherwise exist in this market segment.

The result is that health insurance companies will become financial services organizations more than insurance entities. Think of them as another form of banking, where minimizing transaction costs becomes imperative, and where the use of derivatives and other hedges makes the difference in who makes money and who doesn't.

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Fun in San Diego next week: mHealth & Healthcamp

By Matthew Holt

Next week there’s post-Labor day health care fun in San Diego. The 2nd mHealth Networking Conference is Sept 8-9 and Healthcamp San Diego is the day before (Sept 6). Both are run by good health care friends—Peter Waegemann and Claudia Tessier (who used to run TEPR) now run the mHealth conference, and Gregg Masters is running Healthcamp.

There do seem to be rather a lot of mHealth conferences this year—I won’t start talking here about my disdain for the term—but this is the one in the nicest place and is probably the best value for money! And the keynote is another friend and very interesting techie doctor, S. Cal Permanente Group’s CMIO John Mattison.

Check out the conference program for details and online registration to the mHealth Conference. And sign up for the almost free Healthcamp unconference the day before.

The Accidental Socialists

By DAVID DRANOVE

Over the next few years, the U.S. healthcare system will be in the hands of academics from Cambridge, Massachusetts. New CMS Czar Donald Berwick was a member of the Harvard Medical School faculty. Joe Newhouse, who has been the senior adviser to Medicare for as long as I can remember, holds appointments in three different schools at Harvard. David Cutler, Dean of Harvard’s Undergraduate College, seems a good bet to lead the Independent Medicare Advisory Board. Countless of their colleagues and former students have taken key policy making positions in Washington.

I know most of these scholars. They are brilliant as a rule and are acting in the truest sense of public service. None of them are socialists in the usual sense of the word; they do not believe that the government is an efficient provider of most goods and services. I don’t think they want the government to provide health care either. They have never called for government ownership of hospitals or suggested that physicians join the civil service. But whether they realize it or not, they are the vanguard of a movement bringing socialized medicine to America.

My Cambridge colleagues are mostly economists and know a lot about how markets do and do not work. They have learned from economic theory and practical observation that free market health insurance is imperfect. Fearing adverse selection, unregulated insurers take steps that leave some individuals uninsured, while other individuals choose not to buy insurance and free ride off of taxpayer subsidized charity. Most economists (myself included) agree with this diagnosis of the problem with insurance markets.

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Running Behind

By ROB LAMBERTS

I walk into the exam room and the patient looks up at me with a surprised expression.  ”Wow!  I didn’t expect to see you so quickly!”

I smile and turn around to walk out of the door, saying: “Sorry!  I’ll leave then and come back later.”

“No, no!”  They respond, smiling.  ”I’m happy to see you so soon.  It’s just a surprise.”

I walk back into the room with a smirk.  ”I just don’t want to offend you by being on time.  I’ll try to do better next time.”

I am not sure if I should be happy or sad with such an interchange.  On one hand, it feels good to stay on time with my appointments, holding up my end of the bargain of the schedule.  On the other hand, the patient’s surprise betrays the fact that this is not the usual state of affairs.  And it isn’t.  I generally don’t run on time and don’t expect to run on time.

When I first started practice, the stated objective was to get the person out of the office within an hour of their scheduled appointment.  This seemed a blend of realism and responsibility.  At first it was easy to stay up on things.  My schedule was sparsely filled, so I could make up time.  After sixteen years of practice, however, my schedule almost never has open slots; when it does have openings, they are quickly filled.  I still try to get them out within an hour.

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Medicaid EHR Incentives – A Learning Experience

By MARGALIT GUR-ARIE 

By now almost everybody that has any remote interest in Health Care is aware of the much publicized incentives made available to health care providers for the adoption and meaningful use of certified EHR technology. The most quoted number is $44,000 to be paid by CMS to Medicare physicians. Practically every EHR vendor website is adorned with a Flash banner “educating” doctors on this cash windfall, and practically every HIT detractor is warning that the incentives are just a pittance compared to the real costs of ownership of a certified EHR. Very rarely does anybody go into the intricacies of the available incentives for Medicaid providers, which are almost 50% higher than Medicare and involve clinicians providing care to our most vulnerable citizens. However, there is much to learn from the structure of the Medicaid incentives program.

The HITECH statute sets forth a “net” average allowable cost for purchasing and implementing an EHR at $25,000 for the first year and $10,000 for subsequent years. Of this “net” allowable cost, the Secretary of HHS is authorized to pay Medicaid Eligible Providers up to 85% in stimulus incentives for a total of 6 years. It appears that the Government is about to pay you 85% of your EHR costs for the next 6 years, which is a pretty good deal. Looks, however, can be deceiving. As any early adopter of EHR knows, the total cost of ownership for an EHR over 6 years is well over the “net” allowable of $75,000 set forth in the HITECH Act, and Congress knew that too. This is why the statute instructs the Secretary of HHS to determine the actual average allowable costs of EHR:

“(C) For the purposes of determining average allowable costs under this subsection, the Secretary shall study the average costs to Medicaid providers described in paragraph (2)(A) of purchase and initial implementation and upgrade of certified EHR technology described in paragraph (3)(C)(i) and the average costs to such providers of operations, maintenance, and use of such technology described in paragraph (3)(C)(ii). In determining such costs for such providers, the Secretary may utilize studies of such amounts submitted by States.”

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A Meaningful Use and Standards Rule FAQ Part II

By JOHN HALAMKA

As a followup to the HIMSS Webinar I gave last week, here's an FAQ in the spirit of last month's Meaningful Use and Standards Rule FAQ.

1. The Emergency Department is mentioned in 9 Core Measures and 3 Menu Measures, yet industry discussions seem to focus on the ED for CPOE and Discharge instructions. What functions do ED Information Systems need to support? Are these functions for just admitted patients or all ED Patients?

In my conversations with CMS, I believe that CMS will be issuing a corrections notice to clarify the role of the ED in the rule.

2. There are 44 Quality measures for Eligible Professionals. Do EHRs need to support all 44 measures to be certified?

To achieve certification, EHRs must support the 3 Core Measures, the 3 Alternate Quality Measures and at least 3 others from the remaining 38 measures.

3. Can eligible professionals from ancillary service providers such as stand alone radiology imaging centers qualify for meaningful use?

Although it seems a bit of stretch, if these professionals can meet all the meaningful use measures, then can qualify. This implies that radiologists will have to chart weight/height, ask about smoking status, record race/ethnicity etc.

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Health 2.0 Europe: Etienne Caniard

By Bianca Grogan

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Etienne Caniard of the French National Authority for Health spoke on the French governement's approach to Health 2.0 technologies.

Health Reform Without Apologies

By JOHN GOODMAN

Have you ever seen a fair, unbiased, evenhanded explanation of the Patient Protection and Affordable Care Act? Have you ever seen anything that even appeared to be objective? I haven’t.

So to fill the gap, my colleagues and I have produced“What Does Health Care Reform Mean To You? A Consumer’s Guide,” which explains how the new health care overhaul works, in a question-and-answer format. You can also get a pamphlet version— ideal for doctors’ offices, clinics, work places and everywhere else that people meet and socialize.

That it’s the first effort anyone has made to even try to be objective is in itself rather amazing. See if you agree on whether we succeeded and give us your comments.>

During the nine-month period leading up to the passage of the Patient Protection and Affordable Care Act (PPACA), Americans were subjected to more than $200 million worth of TV, radio, newsprint and Internet ads. Almost all of these — pro and con — were pure propaganda.

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“Healthcare” vs. “Health Care”: The Definitive Word(s)

By MICHAEL L. MILLENSON

A recent contributor to this blog wondered about the correctness of “health care” versus “healthcare.” I’d like to answer that question by channeling my inner William Safire (the late, great New York Times language maven). If you’ll stick with me, I’ll also disclose why the Centers for Medicare & Medicaid Services is not abbreviated as CMMS and reveal something you may not have known about God – linguistically, if not theologically.

The two-word rule for “health care” is followed by major news organizations (New York Times, Washington Post, Wall Street Journal) and medical journals (New England Journal of Medicine, JAMA, Annals of Internal Medicine). Their decision seems consistent with the way most references to the word “care” are handled.

Even the editorial writers of Modern Healthcare magazine do not inveigh against errors in medicalcare driving up costs in acutecare hospitals and nursinghomes. They write about “medical care,” “acute care” and “nursing homes,” separating the adjectives from the nouns they modify. Some in the general media go even farther, applying the traditional rule of hyphenating adjectival phrases; hence, “health-care reform,” just as you’d write “general-interest magazine” or “old-fashioned editor.”

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Health 2.0 Europe: Keynote by Morten Petersen

By Bianca Grogan

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The Danish government's Morten Petersen discusses Denmark's National e-Health Portal at the Health 2.0 Europe Conference.

The Topography of Ignorance

By PAUL LEVY

Here is a statement* that Oliver Wendell Holmes, Sr., as dean of Harvard Medical School, gave in an introductory lecture to the medical class on November 6, 1861:

Science is the topography of ignorance. From a few elevated points, we triangulate vast spaces enclosing unknown details. We cast the lead and draw up a little sand from the abyss we may never reach with our dredges.

And from Jules Verne, Journey to the Center of the Earth:

Science, my boy, is composed of errors, but errors that it is right to make, for they lead step by step to the truth.

I think you would be hard-pressed to find recent graduates from medical schools who would not understand these quotes and find them inspirational. After all, medical students are steeped in the scientific method. Those who go on to academic hospitals apply that method in their scientific research.

Then they enter the clinical setting, and many put aside that method. They rely on judgment, memory, expertise, instinct, creativity, and anecdote in treating their patients.

Brent James has put it this way:

We continue to rely on the "craft of medicine," in which each physician practices as an independent expert -- in the face of huge clinical uncertainty (lack of clinical knowledge; rapidly increasing amount of medical knowledge; continued reliance on subjective judgment; and limitations of the expert mind when making complex decisions.)

The scientific method relies on establishing a base case against which hypotheses are tested. The base case often does not exist in the clinical setting because there is a large degree of variation in clinical practice. How can a hospital or group of doctors test new approaches of care delivery for efficacy relative to a base case where the base case does not exist?

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Life Saving Errors

By DENNIS GRACE

On March 28, 1979 the Three-Mile Island Unit-2 nuclear power plant experienced a feed system failure which prevented the steam generators from removing heat from the plant. The reactor automatically shutdown but, without the feed system to cool the primary, the pressure in the primary system (the nuclear portion of the plant) began to increase. In order to prevent that pressure from becoming excessive, a relief valve opened. The valve should have re-closed once the pressure dropped by a small amount, but it didn't. The only indication available in the control room showed the valve in the closed position, but that indication was erroneous, representing only that the signal to close the valve (pressure below a set value) had been sent to the valve. Nothing in the system verified the actual valve position. This stuck-open valve caused the pressure to continue to decrease in the system (and ultimately provided a path for spewing thousands of curies of radioactive material into the atmosphere), but the false shut indication prevented the operators from taking actions to mitigate their severe loss of coolant accident.

The primary relief valve design had a history of sticking. That same valve had been involved in at least nine other minor incidents prior to the TMI incident. Most notably, eighteen months before TMI, a similar incident had occurred in another nuclear plant involving a loss of feed and rising temperatures shutting down the plant. In that incident, the plant was just starting up after a maintenance shutdown, so the power level and temperature of the system were not as dangerously high as at Three-Mile Island.

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“If There’s a Doctor on Board, Please Ring Your Call Button”

By BOB WACHTER, MD

Well, it happened again. Last Thursday evening, I was somewhere over Saskatchewan, returning from a lovely Mediterranean cruise, in that uncomfortable semi-conscious state that passes for sleep when you’re flying coach, when the airplane’s PA system rang out:

“If there’s a doctor on board, please ring your call button!”

If you’re old enough to remember the show “To Tell the Truth,” you know what happened next. In the show, four B-list celebrity judges guess which of three contestants holds a certain unusual job. Once the judges have made their guesses (guided by contestants’ answers to a series of questions), the real skunk breeder, or tea taster, or cemetery lot saleswoman is asked to stand. One contestant begins to rise, then checks herself and sits down. Then another. Finally the correct contestant stands. The audience lets out a collective “oooh.”

I’m guessing that the average packed Boeing 777 has at least a handful of doctor-passengers. When the call comes for a physician, I’m sure a few mutter, “no f-ing way” and go back to their Sudoku. But most, I think, respond like I do: we reach tentatively for our call button then, thinking better of it, stop, look around, start again, then finally push the damn thing. Even as we nobly hit the button, in our heart of hearts we hope that we’re number two – our guilt assuaged but our services unneeded.

And that’s what happened on Thursday. I waited a few seconds, heard another “Bing!,” breathed a sigh of relief, was elbowed in the ribs by my son Benjy, and then, shamed into it, hit the button. The flight attendant came over, thanked me, and told me that another doctor had already been selected. “I’m sorry,” I replied, which is weasel talk for “Whew!”

I settled back to “sleep,” but five minutes later she returned. “Perhaps you should come up.”

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To Med Students Considering Primary Care

By ROB LAMBERTS, MD

Dear Student:

Thank you for your consideration of my profession for your career. I am a primary care physician and have practiced for the past 16 years in a privately-owned practice. (At some point I intend to stop practicing and start doing the real thing. It amazes me at how many patients let me practice on them.)

Anyhow, I thought I’d give you some advice as you go through what is perhaps your biggest decision regarding your career. Like me, you probably once thought that choosing to become a doctor was the biggest decision, but within medicine there are many options, giving a very wide range of career choices. It is the final choice that is, well, final. What are you going to do with your life? ”Being a doctor” covers so much range, that it really has little meaning. Dr. Oz is a doctor, and he has a very different life from mine (for one, he’s not the target of Oprah’s contempt like I am – but that’s a whole other story).

Here are the things to consider when thinking about primary care:

1. Do you like talking to people who are not like you?

Primary care doctors spend time with humans – normal humans. This is both good and bad, as you see all sides of people, the good, bad , crazy, annoying, funny, and vulnerable sides. If you see mental challenge as the main reason to do something, and would simply put up with the human interaction in primary care, don’t do it. The single most important thing I have with my patients that most non-pcp’s don’t have is relationship. I see people over their lifetime, and that gives me a unique perspective.

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Health 2.0 Europe Conference Videos

By Matthew Holt

On April 6-7, 2010, Health 2.0, in collaboration with Basil Strategies, held the Health 2.0 Europe Conference  in Paris, France. At long last Health 2.0 has posted the videos from this conference (translating geek speak about digital video formats was harder than we thought). If you go to Health 2.0 TV you can find all of the best on stage moments, including the hosts' opening introduction to Health 2.0, the keynote speakers, the panels, and the demonstrations. We want to start you off with the panel that has been called the best panel ever at Health 2.0, Patients and Online Communities. This panel discussion is about the impact that cultures, languages and context have on care delivery in different countries.

Make sure that you stop by the Health 2.0 website and check out the Europe 2010 Conference videos.

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Op-Ed: The Government EHR

By MARGALIT GUR-ARIE 

No, you didn’t miss anything, there is no Government EHR. But should there be one? And if so, what should it look like?

The argument in favor of a Government EHR goes something like this: If we have 19 Billion dollars to spend on EHR adoption, why not spend a small fraction of that money and buy or build an EHR and make it freely available to all physicians and hospitals? Not a bad idea. I would add that, if we must, we could spend the rest of those billions on training and supporting physicians in their efforts to computerize their records. So how would a Government go about accomplishing such monumental task?

The first option would be a “fixer upper”. Buy something like Epic, which has both an inpatient and an outpatient EHR, hire a team of software developers and hordes of usability and medical informatics experts and set them down to work on the existing product. A slightly less expensive option, which is frequently mentioned, is to use VistA instead of Epic. After all the Government already spent boatloads of money on VistA and many of its users seem satisfied with the product even in its current state. Epic has many satisfied customers as well. Either way, it shouldn’t take more than a couple of years to have a fairly usable product, migrated to new technologies, scaled down for small hospitals and practices and scaled down even more for patients.

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It’s My Life, It’s Now or Never

By LISA SUENNEN

You can walk into a pharmacy any day and buy a test kit to find out if you are ovulating so that you can undertake family planning activities. You can buy home testing kits to screen for high cholesterol, presence of the HIV virus, even illicit drug use. You can also pony up $500 and buy yourself a genetic test kit from 23andMe, a retail DNA testing service, to find out what might be in your genetic blueprint. Hey, you can even visit a fortune teller if you feel that is how you want to make pre-emptive healthcare decisions.

While some might look askew at how you get information to make choices about your life, it is rare that someone steps in and tries to stop you from doing so. In general, the American way is to say, “Hey, you’re an adult and it’s your life. If you want to engage in self-actualization, whether or not it has a scientific basis, that’s your beeswax.”

As medicine has evolved to a point where over-the-counter testing has become more and more accessible, many consumers have responded to the perceived advantages of privacy, convenience and the heightened ability to make health decisions early. In fact, these are part of the key principles espoused by those who believe that consumers have a right to their own healthcare information. The idea is that the information is about you, the healthcare consumer, and thus should be both readily available to you and yours to do with what you wish. And yet, that is not always the case. Often it’s not even close.

Oddly, our healthcare system has evolved in such a way that your medical records are owned by the physician or hospital or insurance carrier that oversees what happens to you, but do not, in the end, belong to you. Essentially, your medical information is owned by some one else. The records are about you, for goodness sake. Why shouldn’t you have full access to the data whenever and however you want just as you would if you took a home pregnancy test?

A story that came out of UC Berkeley this month once again puts this controversy in the spotlight. As part of a long-standing tradition, my alma mater has had a mission to examine “issues of profound societal importance for the benefits of students and the public.” To achieve that objective, they have traditionally asked all incoming new students to read a common book and then take multiple classes that use that book as part of a grander curriculum to study issues of great societal importance. This year, as an alternative to asking students to read the assignment, the university decided instead to “examine the DNA-based technologies certain to alter medical care in the years ahead.” Specifically, students will be offered the opportunity to look at three of their 20,000-plus genes to learn how they digest milk products and metabolize alcohol and whether they need more folic acid, a vitamin found in leafy green vegetables.”

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Trust Me I'm a Doctor vs. Physician Quality Report Cards

By KENT BOTTLES, MD

In Quality Measures and the Individual Physician, Danielle Ofri, MD, PhD, questions the usefulness of feedback report cards for individual providers. She states, “Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. A measly 26% have blood pressure at goal. All my grades are well below my institution’s targets.” (http://danielleofri.com/?p=1169)

It would be better for Dr. Ofri’s patients if these numbers were higher. I think even Dr. Ofri would agree with that assessment. And yet Dr. Ofri’s response to these low scores is that “the overwhelming majority of health care workers are in the profession to help patients and doing a decent job.” And more upsetting is Dr. Ofri’s conclusion where “I don’t even bother checking the results anymore. I just quietly push the reports under my pile of unread journals, phone messages, insurance forms, and prior authorizations.” (http://danielleofri.com/?p=1169)

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