AQA, the ACP and internists


Category : General, Medical Rants

Retired doc has a most interesting rant today – Skepticism about ACP’s initiative in Quality and P4P. I actually feel qualified to comment on this issue, as I have discussed these initiatives with the ACP leadership.

The AQA announced a “starter” set of 26 clinical performance measures.Dr.Alper wonders if the starter set is 26, how many will we finally have to deal with. Evidence changes constantly and therefore the measures would have to be in constant flux but there is always a lag-sometimes a long lag-between changes in evidence and re-adjustments of guidelines.He says “few if any authoritative advisory systems can be trusted without question, let alone applied blindly to individual patients.” He asserts that “the real driver behind the quality movments are the payers.” Thus, only as much quality as Medicare or private insurers are willing to pay for will get done-unless of course it is to come out of the doctor’s pocket”. These two sentences are what it is all about.ACP will function to supply the veneer of concern for patient care to the process and will become an even more powerful controller of who gets to be and to continue to be an internist.

Dr. Alper is also skeptical of ACP motives.”…the eagerness of the ACP to seek a place at the quality table may do more good for the ACP that for its members of their patients”. He says we already have clinical quidelines to spare “But knowing how to keep performance measure implementation from turning physicians into compliers rather than thinkers and robbing us all of the ability to recognize a sick patient remains to be determined”.

I disagree with Dr. Alper on the motivation. The ACP leadership has met with insurers and legislators. The quality train has left the station. Too many “experts” have espoused the value of quality measures for the ACP to ignore this movement.

I believe the ACP has made the right decision – they must be at the table making certain that the right quality measures are chosen. All physicians know that much of quality is immeasurable – A comment on pay for performance.

Nonetheless, whether the ACP (or any organization) participates, we will have pay for performance. The ACP has chosen to participate in hopes of controlling the runaway train. They have made the correct decision (in my biased opinion) that participating in the process is superior to moral outrage.

For those who want to read more on AQA – The Ambulatory Care Quality Alliance.

Disclosure: as I have written previously, I am the President-Elect of SGIM. Our organization has decided to participate in the AQA, and I will be the organization’s representative. This may well bias me in favor of the project, but I voted in favor of participation for all the reasons stated above. This will hapen, and we must make the best of the situation.

free viagra
buy viagra online
generic viagra
how does viagra work
cheap viagra
buy viagra
buy viagra online inurl
viagra 6 free samples
viagra online
viagra for women
viagra side effects
female viagra
natural viagra
online viagra
cheapest viagra prices
herbal viagra
alternative to viagra
buy generic viagra
purchase viagra online
free viagra without prescription
viagra attorneys
free viagra samples before buying
buy generic viagra cheap
viagra uk
generic viagra online
try viagra for free
generic viagra from india
fda approves viagra
free viagra sample
what is better viagra or levitra
discount generic viagra online
viagra cialis levitra
viagra dosage
viagra cheap
viagra on line
best price for viagra
free sample pack of viagra
viagra generic
viagra without prescription
discount viagra
gay viagra
mail order viagra
viagra inurl
generic viagra online paypal
generic viagra overnight
generic viagra online pharmacy
generic viagra uk
buy cheap viagra online uk
suppliers of viagra
how long does viagra last
viagra sex
generic viagra soft tabs
generic viagra 100mg
buy viagra onli
generic viagra online without prescription
viagra energy drink
cheapest uk supplier viagra
viagra cialis
generic viagra safe
viagra professional
viagra sales
viagra free trial pack
viagra lawyers
over the counter viagra
best price for generic viagra
viagra jokes
buying viagra
viagra samples
viagra sample
generic cialis
cheapest cialis
buy cialis online
buying generic cialis
cialis for order
what are the side effects of cialis
buy generic cialis
what is the generic name for cialis
cheap cialis
cialis online
buy cialis
cialis side effects
how long does cialis last
cialis forum
cialis lawyer ohio
cialis attorneys
cialis attorney columbus
cialis injury lawyer ohio
cialis injury attorney ohio
cialis injury lawyer columbus
prices cialis
cialis lawyers
viagra cialis levitra
cialis lawyer columbus
online generic cialis
daily cialis
cialis injury attorney columbus
cialis attorney ohio
cialis cost
cialis professional
cialis super active
how does cialis work
what does cialis look like
cialis drug
viagra cialis
cialis to buy new zealand
cialis without prescription
free cialis
cialis soft tabs
discount cialis
cialis generic
generic cialis from india
cheap cialis sale online
cialis daily
cialis reviews
cialis generico
how can i take cialis
cheap cialis si
cialis vs viagra
generic levitra
levitra attorneys
what is better viagra or levitra
viagra cialis levitra
levitra side effects
buy levitra
levitra online
levitra dangers
how does levitra work
levitra lawyers
what is the difference between levitra and viagra
levitra versus viagra
which works better viagra or levitra
buy levitra and overnight shipping
levitra vs viagra
canidan pharmacies levitra
how long does levitra last
viagra cialis levitra
levitra acheter
comprare levitra
levitra ohne rezept
levitra 20mg
levitra senza ricetta
cheapest generic levitra
levitra compra
cheap levitra
levitra overnight
levitra generika
levitra kaufen

Comments (4)

It should not go unnoticed that the AMA is not yet part of the AQA.I have no doubt that there are sincere physicians who are in fact working to make this whole thing work and I sincerely hope that it does. However,I can’t help thinking of Rand’s concept of the sanction of the victim and our history of gatekeeping and managed care.The payers have already defined the terms of engagement and universe of discourse.Who could be against “quality” and paying people more for doing a better job?

I hope that the efforts of thoughtful, well-intentioned docs such as you will be able to meaningfully alter the process so we all won’t end up with a situation like the UHC mess in St. Louis.I am not sure how much organized medicine sat at the table regarding managed care and gate keeping but if we did the results left a little to desire.I cannot keep two thoughts out of my mind.One is the Randian concept of the sanction of the victim and the other is Lucy holding the football for Charlie’s place kick attempt.

I’m glad you are getting involved. Proper quality management requires the involvement of the people who do the actual work. Physicians seem unaware of it, but almost all serious quality work includes substantial areas where quality has only qualitative metrics. There are ways to deal with this.

I suggest starting by reading the classics from Demming and Juran. These give a start into the serious analysis involved, unlike the fatuous quality books written to attract the management drones with ADHD. You will find yourself inflicted with many of these by the true believers despite any effort to avoid them.

It will not be easy. One of the primary findings of quality work is that a revenge based quality system does not work well. Unfortunately, the US legal system almost mandates use of a revenge based quality system. Resolving that conflict will be hard.

Another problem is the need to have those who actually do the work be primary participants in the quality management process. This requires highly skilled management, which is quite rare in the medical field. Physicians are gradually accepting nurses and other clinical staff as partners. To do quality right you need to accept the participation of everyone as an equal partner.

Finally, designing good quality systems is just plain hard. The Japanese took over 20 years to get good at it. The American automobile industry also took 20 years to show significant progress. It will take decades to build the experience and skills needed for healthcare.

Good luck.

Please see our comments at Health Care Renewal.
The blog is at:
The post is at:

Post a comment