This guest column is written by Dr. David Jadwin, a pathologist who has created a quality review platform that gives physicians unbiased and anonymous feedback based on independently reviewed medical charts. The platform makes possible the extraction of pertinent clinical information from any medical record without requiring an electronic medical record.
June 15, 2012 – The focus of modern healthcare must be directed to preserving the well being and health of Canadians. It is important to ensure that Canadians are receiving high quality, timely and cost effective care. It is likely that fee structures directed towards paying physicians to provide services will not be effective as compensating physicians to ensure better health.
These may at first seem the same goal but they are not. Providing compensation for services drives up costs without necessarily providing safe, quality care. Focusing on producing better health and safer patient care not only achieves the desired outcome but increased quality and preventative care is the most effective way to achieve lowers healthcare costs. The goal of improving healthcare costs needs to come from driving quality, not cutting services.
Physicians, patients and policy-makers must cooperate to bring about a healthier Canadian population and a safer, more effective healthcare system. A safer healthcare system must be quality-driven using new education and improvement tools. There is no evidence that demonstrates that healthcare in Canada is optimal. The Canadian healthcare system struggles to just provide patient care and has little resources with which to dramatically improve care.
Quality efforts are traditionally hospital-based and there is little meaningful way to assess hospital and physician performance except through use of “outcomes data” or “big data”. Outcomes data indicates that there may be a problem and data are typically not directly comparable between physicians and hospitals. For one thing, if institutions are outliers, the physicians wish to believe that their patients are somehow worse off than the norm rather than the fact that their care might not be a good as other providers. The biggest problem with current internal hospital quality systems is that hospitals and physicians cannot objectively self-review their patient care in an unbiased manner.
The solution to the current situation is twofold. First, provide an independent system to fairly and objectively evaluate patient care in a standardized manner so that each patient care event, every physician and every hospital is evaluated in a similar manner. Such a national or at least provincial review process will bring about transparency in healthcare delivery that is currently not possible.
If patients, organizations and government can measure discretely and objectively how healthcare is actually being delivered, then a true level of accountability can be effected to move physicians and hospitals in a more positive direction. The second solution is to devise compensations that reward physicians for providing better care and better results, rather than simply compensating physicians to provide mere services. To be successful, the Canadian health system will need to invest in inexpensive technology and services that can measure healthcare performance in a fair and effective manner, educate providers how to provide better care, and produce data that can be used to provide appropriate compensation to physicians.
Physicians must be rewarded in appropriate ways to achieve the desired response: a safe, quality healthcare system, cost-effective healthcare services, happy patients and contented physicians. With the appropriate government, physician, hospital and patient leadership Canada can immediately achieve these goals. Dr. David Jadwin is the Chief Executive Officer/Chief Medical Officer at Columbia Healthcare Analytics, Inc. and the former Chair Department of Pathology at Kern County Medical Center and Member, Government & Professional Affairs Council at College of American Pathologists.
