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We Are No Longer Alone

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I’m writing to you from Idaho Falls, Idaho where it is going to be a balmy minus 6 degrees tonight and there is snow on the ground. Tomorrow, I will be spending the day at Rigby High School, where Stefani Cook, (ID 2011) teaches, conducting a site visit for our research study with Pearson and Digital Promise.

I think that my message this week would fall under the heading of “We Are No Longer Alone” if I could entitle it. Have you seen the article in the NY Times on New York City’s response to the Affordable Care Act:  http://www.nytimes.com/2013/01/12/nyregion/new-york-city-hospitals-to-tie-doctors-performance-pay-to-quality-measures.html?_r=0. Moving away from compensation models that reward doctors and hospitals for the number of procedures they perform, the city is moving towards a pay for performance system, through which doctors will be compensated, in part, based on metrics around patient satisfaction, patient recovery, and similar factors, still be negotiated.

Currently, this is being thought through for physicians in the city who are part of the city public hospital system – like teachers, basically public employees, to some extent.  You might think that most physicians are private practitioners; however, this is starting to change.  As insurance premiums, time spent bookkeeping, and other office-related tasks take up more and more time and money, many doctors are leaving their private practices and joining ‘groups’ often under the auspices of a hospital system.  In my rural community, my general practitioner, gynecologist, and allergist have all recently gone this route. So, the number of physicians affected may indeed be large.

Let’s look at some of the concerns expressed by physicians and their union:

  • “…doctors are hesitant, saying they could be penalized for conditions they cannot control, including how clean the hospital floors are, the attentiveness of nurses and the availability of beds”; does this sound familiar – working conditions conversations?
  • “…the consequences in a complex system like a hospital for giving an incentive for one little piece of behavior are virtually impossible to foresee,” ; again, sound familiar?
  • “…the union has also proposed expanding the indicators to 20, including measures that would give doctors bonuses for going to community meetings, giving lectures, getting training during work hours, screening patients for obesity and counseling them to stop smoking.; this sounds like the conversation that we have been having around multiple measures and what those measures should be, as well as somehow accounting for the many things that teachers do outside the classroom.
  • “… it has also proposed excluding some patients — like developmentally disabled patients, homeless people and those who have no place to go — from incentives aimed at reducing the time patients spend in the hospital.”  And again, this reminds me of the conversations that we have had about the level of responsibility to which teachers should be held accountable for the family/home conditions of their students.

I wanted to reach out to the physicians coming to grips with this new world order and say, “Welcome to the world of the classroom teacher.”  Since physicians are only just beginning their journey down the performance compensation pathway, there are many concerns that they have not yet thought through.

For example, should there be different standards for some of the thirteen factors currently identified to which they will be held accountable, for physicians in different fields?  How will the industry validly measure some of the thirteen constructs that have been identified?  And, how will they unravel the home care factors from overall patient recovery?  I think that the education field could serve as good mentors as this moves forward.

But the most important take-away for us, is that we are beginning to see how performance compensation will roll out for professions other than teaching.  If you want a fun exercise, play this out for auto mechanics, research scientists, or other fields.

We in teaching have been fortunate in having had the benefit of some in-depth, targeted research looking at the validity, reliability, and fairness of prospective measures.  And, we have had the guidance of research-based assessment companies informing conversations.  I could not tell whether or not similar safeguards had been put in place for these changes for physicians.

For once, maybe the medical field could learn something from the teaching model.  😉




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