Sacrificing Customer Service for Quality Metrics?

A greater emphasis is being placed on meeting quality metrics than customer service for physicians. Is this a good thing?

A few weeks ago I received an email from the Independent Physicians Association (IPA) I am a part of.  It was announcing there would be a change in their payment model with a bigger emphasis on “quality.”  Quality refers to meeting certain evidence-based measurable categories (also called metrics) to assure doctors are practicing medicine well.  Examples include getting a majority of blood pressures under 140/90, getting diabetes under control with an a1c under 8 and getting patients over 50 screened for colon cancer.  Essentially, through chart reviews, the IPA is able to see how well I do in these and other categories and adjust my payment based on results.

Within this email was further information on how this payment was going to be disbursed.  Money that used to be given based on patient satisfaction was being moved into the quality category.  Essentially a greater emphasis was being placed on quality metrics than patient satisfaction. This initially irked me because I do very well in the patient satisfaction department.  I take time and care for my patients with a genuine attention and this is reflected on my patient satisfaction scores.

I also do my best with the quality department but sometimes find it difficult to get all patients within the metrics set. Part of this is because some of these quality metrics are outside of my control.  For example, I can refer a person for a colonoscopy but I cannot make them get it done.  I can adjust medications for diabetes and blood pressure but if the medication is not taken or the person is not adhering to a proper diet and exercising, their numbers may not improve.  I feel like patient satisfaction is under my control whereas metrics may not be.

So, why the shift?

It is extremely important to provide a quality product that improves and lengthens lives.  This is what the world looks at when judging how well doctors are doing.  Customer service is secondary.  Both are important and ideally, a doctor provides both, but when it comes down to it, our job is in health and the best way to judge this is through these quality metrics.

My Take

In the long run, this will be a good thing. If we meet the mark set for each of these metrics, patients will benefit with less death and disability from disease processes. I hope that doctors will not throw their customer service skills by the wayside and solely focus on achieving the quality metrics.  My biggest concern with this shift is that doctors may start sacrificing customer service for quality metrics.

Personally, I will continue to provide excellent customer service.  This shift has motivated me to make a more concerted effort to make sure I meet the measures.  I will likely be a little more assertive in convincing my patients to get tests done and make medication changes to improve control of their disease.  I need to be aware of doing this in a gentle and non-coercive manner to maintain patient satisfaction. So for me, this will be a good thing and there will be an improvement.

So don’t be surprised if your doctor starts to work harder to control your blood pressure, get your A1c down for your diabetes or get certain tests done.  Hopefully, this is still done in a respectful manner that shows superb customer service as well. This will translate to a more healthy life for you. With all this, I’m curious what you think. Comment below and let me know.

2 thoughts on “Sacrificing Customer Service for Quality Metrics?”

  1. Quality medical care for an individual and meeting aggregate metrics for a population are really variations of each other. The limitation of metrics, of course, is that it is not always the best thing that is being measured. Most primary NP’s have better HbA1c data than I do but they are not the same patients. I think the principle is the same, though. If somebody would benefit from more aggressive insulin, do it, if they would be harmed, don’t do it. If they’ve had angioedema from lisinopril, don’t prescribe it again and just fly the deficiency letter into the wastebasket. After all, our exam rooms are really just a collection of individuals that we see. Somebody else will total up what we did later. They won’t total up why we did it, though.

    1. I agree wholeheartedly. Individual and population based management are different. What is good for the person in front of you may make your metrics go down. We need to always adhere to our mantra of first “doing no harm.”

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