Jerome Groopman Weighs In On Tiering; Evokes Orwell, Kafka

Dr. Jerome Groopman, the Boston physician who has written bestsellers and writes for the New Yorker, writes a scathing indictment with Dr. Pamela Hartzband on the pitfalls of current pay for performance programs in today's edition of the Wall Street Journal. This section of the article on the GIC's tiering program is priceless:

"Too often quality metrics coerce doctors into rigid and ill-advised
procedures. Orwell could have written about how the word "quality"
became zealously defined by regulators, and then redefined with each
change in consensus guidelines. And Kafka could detail the recent
experience of a pediatrician featured in Vital Signs, the member
publication of the Massachusetts Medical Society
. Out of the blue,
according to the article, Dr. Ann T. Nutt received a letter in February
from the Massachusetts Group Insurance Commission on Clinical
Performance Improvement informing her that she was no longer ranked as
Tier 1 but had fallen to Tier 3. (Massachusetts and some private
insurers use a three-tier ranking system to incentivize high-quality
care.) She contacted the regulators and insisted that she be given
details to explain her fall in rating.

"After much effort, she discovered that in 127 opportunities to comply
with quality metrics, she had met the standards 115 times. But the
regulators refused to provide the names of patients who allegedly had
received low quality care, so she had no way to assess their judgment
for herself. The pediatrician fought back and ultimately learned which
guidelines she had failed to follow. Despite her cogent rebuttal, the
regulator denied the appeal and the doctor is still ranked as Tier 3.
She continues to battle the state."

Read the full article in Vital Signs here.

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