What We Can Learn from the Airlines
Did you know that 79.5% of all U.S. flights were on time last year? Or that this mark was better than previous years? Odds are, you haven’t noticed any increased speediness on your flights, however. Odds are, there has been no reduction in overall tardiness at all. Perhaps you’ve noticed that flights that used to be scheduled for 2½ hours, are now 3. What was once 3, is now 3½. So on time arrivals go up — with a stroke of a pen!
Here’s the lesson for health care. Just as providers currently maximize against third-party reimbursement formulas, they will maximize against third-party quality measurements as well. But that doesn’t mean quality of care has actually improved. In fact, having providers meet artificial yardsticks can actually harm the overall quality of care.
You all had a post on the VA system a number of months ago and this is exactly what was happening. The VA was scoring well on the dimensions on which they were measured (held up as a national model,in fact), but the system performed poorly in every other dimension.
This is the way the whole hospital sector is going to respond to Obama Care.
The airlines don’t bother me as much as the security check-in and arbitrary rules for flying. That’s similar to how socialized medicine works, where a government gatekeeper (e.g. the same people who hire and train the security check-in people) restricts or delays entry into the queue.
I think your conclusion is correct, but you stretched the airline analogy a little too far. To me, the real problem with third party measures is that they only work once. I just picked up on your point, posted over at Healthcare Neutral ADR Blog:
http://www.healthcareneutraladrblog.com/2010/02/articles/commercial-healthcare-disputes/will-healthcare-providers-game-quality-measures/
Besides the stretch in flight times, I’ve noticed something else as well. Airlines used to hold planes at the gate. Now they slam the door and leave the gate and we now sit on the tarmac instead of at the gate. So technically, the plane has departed the gate on time, but us passengers know the score.
[…] Hint: It’s the same thing the schools learned from the airlines. […]