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Unintended Consequences of the Wrong Measures | @ExpoDX #DX #AI #BigData #Analytics
Applying baseball sabermetrics lesson to healthcare
By: William Schmarzo
Nov. 26, 2017 05:00 PM
In an attempt to put the patient first in healthcare, Congress and President Obama in 2015 approved a bipartisan bill for United States healthcare reform. The bill is known as “Medicare Access and CHIP Reauthorization Act of 2015,” or MACRA. Among the major provisions of MACRA is the Quality Payment Program. Under the Quality Payment Program, physicians and nurses receive positive, neutral or negative Medicare payment adjustments based upon a “Patient Satisfaction Score,” that is, patient satisfaction scores have a direct impact on how physicians, physician assistants, nurses, and hospital’s get paid by Medicare.
Managing the broader healthcare goal of “Improving the Quality and Effectiveness of Patient Care” from a single, highly generalized measure is a major concern for physicians and hospitals. These “patient satisfaction scores” can drive unintended patient treatment consequences. For example, some patients may have preconceived expectations about treatments and medicines based upon what they read on sites like WebMD. Patients may become dissatisfied when physicians prescribe more relevant treatments and that patient dissatisfaction may be reflected in the patient satisfaction scores. As a result, physicians may feel pressured to consent to patient demands for unnecessary tests or to overprescribe pain medications to avoid being penalized on patient satisfaction surveys and receiving a lower reimbursement – a situation that may be contributing to today’s opioid epidemic.
My nephew is an Emergency Room doctor and he confirmed that there is lots of pressure on hospitals, physicians and nurses to do what the patient wants (in order to get higher patient satisfaction scores) versus doing what’s right for the patient (which might lead to lower patient satisfaction scores). I know that I get frustrated when my doctor tells me to exercise more and eat more healthy foods. I know that’s what’s right for me, but I could easily penalize the doctor for telling me “what I need to hear” versus “what I want to hear” (i.e., eat more Chipotle and watch more TV while lying on the couch).
Setting the right metrics is a tricky effort because as John Smale, former CEO of Procter & Gamble, used to say:
That is, people will do what they are paid to do. If hospitals, physicians and nurses are reimbursed to increase patient satisfaction, then doing what the patient wants is the rationale choice.
Baseball Analogy: Importance of the Right Measures
Let’s say, for example, we are trying to determine the value of a hitter. Today, Mike Trout (California Angels) and Bryce Harper (Washington Nationals) are considered two of the best hitters in professional baseball. Their offensive performance statistics – both career-wise and for the current season – speak for themselves (see Figure 1).
Figure 1: Harper and Trout’s Offensive Performance
And while there is an extensive set of offensive productivity measures against which to judge a hitter’s performance, it isn’t just hitting that determines a player’s value. Fielding effectiveness is another consideration, and both Harper and Trout excel in that category as well:
Baseball has tried to create a single super metric – Wins above Replacement or WAR – that is, an attempt by the sabermetrics baseball community to summarize a player’s total contributions in one statistic. WAR is all-inclusive and provides a useful reference point for comparing players (see Figure 2).
Figure 2: Components of the Offensive WAR Calculation
However, even with WAR there is no single measure. There are many subcategories of offensive WAR including:
The sabermetrics community warns against using a single metric to evaluate the effectiveness and value of a player. No single measure can truly determine a baseball player’s value, and likewise no single measure can be used to determine the quality and effectiveness of patient care. Baseball gets it!
Applying Baseball Sabermetrics Lesson to Healthcare
Role of Patient Analytic Profiles
Analytic Profiles capture the organization’s analytic assets to facilitate the refinement and sharing of those analytic assets across multiple use cases. An Analytic Profile consists of metrics, predictive indicators, segments, scores, and business rules that codify the behaviors, preferences, propensities, inclinations, tendencies, interests, associations and affiliations for the organization’s key business entities.
Patient Analytic Profiles are important because they allow hospitals and care givers to use a more holistic set of measures to determine the quality and effectiveness of patient care. For example, we could create a Patient Analytic Profile that captures key predictive metrics and scores for each patient that measure overall patient health and wellness including Diet Score, Exercise Score , Stress Score and an overall Wellness Score (see Figure 3).
Figure 3: Patient Analytic Profile
See “Analytic Profiles: Key to Data Monetization” for more details on the Analytic Profiles concept.
The public is not always a reliable source of what’s good and what’s not good. Remember the Internet phenomenon movie called “Snakes on a Plane”, a film that is now universal shorthand for “hideously bad”?
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