Chapter 1.B.5--Evidence-Based Medicine

Medicare now requires hospitals to participate in public reporting of 10 comparative quality measures (focused on heart failure and pneumonia) in order to obtain full reimbursement.  For more information see Medicare's Hospital Quality Initiative web page.

Documenting the role that physician discretion plays in driving medical spending and treatment patterns, see Brenda Sirovich, et al., Discretionary Decision Making by Primary Care Physicians and the Cost of U.S. Health Care, 27(3) Health Aff. 813 (June 2008).

Dramatic variations in physicians' practice styles received national attention from a compelling article in The New Yorker magazine by Atul Gawande, "The Cost Conumdrum:  What a Texas Town Can Teach us About Health Care,"  June 2009.   President Obama reportedly had all of his staffers read the article as revealing one of the fundamental problems in U.S. health care, and therefore most everyone else involved in the health care reform debate quickly read it, making it an "instant classic."

These are examples of health plan performance measures included in the [HEDIS] Health Plan Employer Data and Information Set

Measurement Goal	Category	Measure
Quality	Preventive medicine Prenatal care Acute and chronic disease Mental health	Childhood immunization Cholesterol screening Mammography screening Pap smears for cervical cancer Low birthweight Prenatal care in first trimester Asthma admissions/readmissions Diabetic eye exam Treatment following heart attack Readmission rate for treatment of   major affective disorders
Access and satisfaction	Access Member Satisfaction Membership	Percent of members age 42 to 64 with   plan visit in previous two years Waiting times Members who had no problem receiving   care or referrals Percent of members who are "very satisfied"   with plan Provision of satisfaction surveys Enrollment/disenrollment
Utilization	High occurrence/high cost	Frequency and average cost of five selected   procedures

Return to home page.