Who Should Measure Your Doctor's Performance and How?

They say you get what you measure. But, in Sick Care, what "they" don't say is who should do the measuring and how. There has been a firestorm around maintenance of certification (MOC); using the "patient experience" to judge physicians has come under scrutiny and linking board certification to outcomes is questionable.

So, given that the stakes are getting higher and the pace of change is getting faster, who should measure your doctor's performance and how and what should they do with the results?

So far, it has mostly been doctors measuring themselves, or doctors measuring doctors in the form of specialty boards and MOCs. That has evolved into payers, both private and public, getting into the act and creating carrots and sticks. Then, of course, there are patient-customers measuring doctors on the Internet and via the rapidly growing patient satisfaction industry. All of this activity has introduced more stress and confusion for everyone involved. It has intensified the fault lines and is further damaging the doctor-patient relationship.

Given how the rules and technologies have evolved, physician performance metrics technologies will likewise evolve to reflect the new realties. Data transparency and public information profiles hopefully will give stakeholders the information they want and need, to include:

1. Education, training and professional improvement activities

2. Disciplinary actions and violations

3. Experience in a given field, number of surgeries of a given type, or the types of patients seen

4. Outcomes, in the form of compliance to certain professional standards and within defined limits of deviation or, eventually, number of diagnostic mistakes

5. Defining and measuring competencies, particularly when it comes to using new technologies

6. Cost data to reflect the amount of resources consumed to arrive at a satisfactory outcome when compared to peers

Here's a quiz:

1. How many operations and what kind has your doctor done?

2. How many patients had complications and which ones?

3. Has your doctor lost their license in another state?

4. How much was wasted on your care?

If you got any of these answers correct, you are probably fibbing or live somewhere in another galaxy. Someday, hopefully soon, we will indeed get what we measure and we will like the results.