Compliance is Not Quality

I am a little surprised (and somewhat dismayed) by the perspective of many of the competent clinicians that I speak with about quality management.  Many will speak of the various federal reporting initiatives (e.g., PQRS for Medicare FFS, STARs for Medicare Advantage, CQM for Meaningful Use, etc) and suggest that their quality standards are performing well.

I usually respond with “What quality standards?”

Federally established performance metrics are compliance standards, not quality standards.  Some of them may actually impact quality, but many do not.  Does anyone think that BMW sets their performance standards based on the federal government?  WalMart?  Cisco?  Verizon?  Does BMW compete on their federal mileage rating?  Does WalMart brag about SOX compliance? Does Cisco advertise their unqualified audit?

Quality should generally be something that is understood by the consumer of the product as a value.  I recognize that it is often true that the payer for the product is not the consumer, but the selection of the product is usually a consumer issue.

Were I in an orthopedic group, it would be reasonable for my group to set standards for performance that would be understood by our customers- the patients selecting our group.  We might select major joint device failure rate over 10 years, or pain and range of motion six months post discharge or incidence of  infection.  All of these are items that a consumer of major joint services would understand and value.  We certainly would not expect a consumer to care about his orthopedic surgeon’s HEDIS scores.

Can we stop characterizing compliance as quality and focus on real consumer-understandable quality metrics?  I am looking forward to the development of real, competitive quality metrics.  It will be relatively easy to establish meaningful quality metrics for procedural specialties (although it will be somewhat more difficult to actually collect the relevant data).  It will be slightly more challenging to establish and collect meaningful quality metrics for medical specialties/subspecialties, but it can be done.

Has anyone seen innovative competitive quality metrics to report?


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