Why don’t they ever try to change the way slip and fall lawyers get paid?
I'll tell you, at the risk of upsetting some attorneys that might be on this site. The fact is that many attorneys resent physicians, and attorneys happen to be very well represented in American government (e.g. Obama, the Clintons, a ton of people in the Senate and Congress). There are lots of honest attorneys with high ethics and a desire to do good, but by and large attorneys have a lesser degree of trust and stature among the public than do physicians. That's just the way it is, fair or not.
Add to that the fact that one of the most compelling reasons that drives people to run for public office is that they have components of narcissism, grandiosity, and the need to ‘get credit’ as big parts of their personalities, and you have the perfect formula for attorney politicians, like Obama, resenting physicians. It's just a fact.
The problem is that in their zeal to ‘knock physicians down a peg, or two, or three etc.’, they keep hurting the people physicians are trained to help.
Quality measures are very, very, very flawed, and if they progressively tie a physicians ability to make a livelihood to government-defined outcomes measures, what will happen is that you will see rationing of care by physicians. If I am going to be ‘judged’ and paid on the basis of outcomes, and they are going to judge my quality of care on this basis, it becomes in my best interest to avoid taking care of patients who are likely to have poor outcomes (e.g. the significantly elderly, those who have genetic or lifestyle-related contributors to a worse outcome etc.).
If you do surgery/procedures, you aren't going to do high risk procedures anymore, because it will just decrease your ‘quality score’. So those with the most advanced and challenging disease burden will find it harder to get treated. Instead, these people won't get procedures and surgeries, but will be treated ‘conservatively’. This will make the government happy, because it will cost less, and the blame for rationing will have been shifted to the physicians.
This is a very accurate real life example: A man who is out shopping has a heart attack because of an occluded coronary artery. He had some chest pain, but thought it was heartburn, so didn't seek urgent medical care. Unfortunately, because his heart muscle isn't getting enough blood flow, he has abnormal electrical activity in the heart (an arrhythmia) and suffers sudden death. He is found down in the aisle of the local grocery store, and one of the customers knows CPR and starts resuscitation.
The store manager calls 911, the EMTs arrive, and the man is ‘shocked’ into a normal heart rhythm. They also place an endotracheal tube to ventilate him better. He remains unconscious, and no one is really sure how long he was ‘down’ before the CPR started, or whether or not he is likely to have severe brain damage or brain death. When he gets to the emergency department of the nearby hospital, an ECG shows that he is having a heart attack.
A cardiologist is called, to see if the patient should be taken immediately for a procedure to open his blocked artery and stop his heart attack. The cardiologist knows that the statistics regarding survival after an ‘unwitnessed’ out of hospital cardiac arrest are poor, and that this man is likely to die. He also knows that if he takes the patient for a procedure, opens the patients blocked artery, but the patient then goes on to die within the next day or two, the patient’s death will be linked to his procedure (statistically), and will count against him as a peri-procedural death. In Obama’s world, this will mean that this physician's ‘quality rating’ will go down, and by doing the right thing (stopping the heart attack, hoping that the patient did not sustain brain death prior to reaching the hospital, and giving the patient the best chance) this physician will risk his ‘statistical’ quality score-based reputation.
Some physicians will choose to say, ‘to hell with the statistics, I'm going to give this man the best chance possible to live’, but some may choose otherwise. They will use ‘statistics’ to rationalize their inaction, and their personal statistics will look better because of their choice. Are these really the ‘highest quality’ physicians? I don't think so.
It's all really kind of sick.