Who Determines “Quality” in Your Health Care?

April 22, 2013 

The Patient Safety and Affordable Care Act brings with it significant new initiatives to measure quality of health care in America. Who develops those quality standards? According to the latest issue of the Texas Medical Association’s (TMA’s) Texas Medicine magazine, physicians are playing a substantial role in crafting and implementing them.

“These [quality measures] applied to physicians, or by which we are measured downstream, are what our individual specialty societies thought were very important to measure,” said Ronald S. Walters, MD, a Houston oncologist and member of TMA’s Council on Health Care Quality. Physicians specialize in different areas of medicine, like cardiology or pediatrics. Their specialty societies focus on the unique needs and demands of patients within their own specialty — and how to measure whether medicine is providing quality in meeting those needs.

As health care inches towards a value-based payment system that factors both costs and care improvement, and as measures become more sophisticated and less voluntary, Texas physicians stress the importance of taking part in the process of creating quality measures.

For physicians, that process starts with the medical evidence. Several organizations composed of physicians across specialties review the evidence to determine the extent to which a potential measure could alleviate both physical and fiscal health costs. “We look at the disease burden: how many patients are affected and how much we are paying as a nation,” said Ghassan F. Salman, MD, an Austin internist who helps draft quality measures. Dr. Salman also is a member of TMA’s Council on Science and Public Health, and a liaison to TMA’s Council on Health Care Quality.
For example, most of the early measures focus on chronic illnesses such as heart disease, obesity, diabetes, and cancer — high-impact and high-cost areas. Once a measure is identified, reviewed, and tested on a small scale, physician members of the quality organizations test the measure on a larger scale “to see if it did work in real life, and if physicians can live with it,” Dr. Salman said. If all goes well, the measure is adopted as a national standard.

The rigorous process does not stop there. Health care quality organizations continue to evaluate the measure to see if it provides value and if it needs revision. An important part of this process is tracking the outcomes of the measure, though physicians caution that outcomes are often difficult to measure.

“You’ve no doubt heard the phrase: ‘The operation was a success but the patient died,’” said Robert B. Morrow, MD, medical director of quality for the Rural and Community Health Institute at Texas A&M Health Science Center. “Sometimes people get very good care and have what we all agree is a poor outcome. By the same token, you can have poor care, but a good outcome. We are people, after all.”

The quality measures out there are not perfect, nor are they the same ones that will exist five years from now, say Texas physicians. But following quality standards “would be in the best interest of patients, if they were to ask, and makes us [physicians] more efficient, which is the goal,” said Dr. Salman.
TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans. 

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