New York Times health articles rarely rise up to #1 on "Most Emailed List". Yet looks like the recent piece "Why Doctors So Often Get It Wrong" really struck a chord with readers and did just that.
No question, the article does not give the full physician's side of the story. Many medical bloggers (Notes from Dr. RW, DB's Medical Rants, Kevin MD) already weighed in on some key factual errors.
But let's not miss the forest behind the trees.
Fighting the public's perception that there is room for improvement in health care quality is a losing proposition, both politically and economically. Skyrocketing health care costs make demands for accountability inevitable. Pay-for-performance is an easy concept for the public to grasp and ignoring this is an indefensible position:
There is no bonus for curing someone and no penalty for failing, except when the mistakes rise to the level of malpractice. So even though doctors can have the best intentions, they have little economic incentive to spend time double-checking their instincts, and hospitals have little incentive to give them the tools to do so.
"You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality."
There are some bits of good news here. Dr. McClellan has set up small pay-for-performance programs in Medicare, and a few insurers are also experimenting. But it isn't nearly a big enough push. We just are not using the power of incentives to save lives. For a politician looking to make the often-bloodless debate over health care come alive, this is a huge opportunity.
So answering the question: "What quality info do you have to hide?" is a lot like "Why US ports are being turned over to Arabs". The public will never care about details, but emotional first impression will stick.
New York Times is merely picking up and amplifying the wave that Intel's Craig Barrett has been warning about.
Now, even AMA is beginning to recognize the shifting landscape. Renown for its opposition to pay-for-performance ("Rep. Bill Thomas Locks Horns with AMA"), the group has been put in the position of having no other choice by pressure from Congress, as a commenter at KevinMD remarks ("Did the AMA bow to Congressional pressure on pay-for-performance?"):
If one reads between the lines of the memo and working agreement, and has any knowledge of or experience with the staff or the procedures of the AMA, one can come to only a single conclusion - there simply wasn't any choice here other than "signing on" to the process.
The federal government planned to impose SOMEONE's idea of "pay for performance" on America's doctors whether the AMA liked it or not, and, then dangled reversing the CLINTON ERA paycut as a way to persuade the AMA to participate in the process....
Still just as the public gets emotional over the cost and quality of care, so are many doctors over what is looming on the horizon: "The AMA Screws Physicians By Supporting Pay-for-Performance". The difference is that as providers of services, physicians have an economic stake in putting emotion aside and pursuing the rational course of action.
With political response having slim chance of success, can it be anything other than adapting to P4P future before it arrives?