Say it isn’t so

Say it isn’t so

The headline almost seems to be an early April’s Fool joke but there it was in today’s Wall Street Journal – “Actively Managing Chronic Conditions Shows Few Benefits”. This has to be a joke right as everyone knows patients who actively manage their diabetes see improved outcomes. Hasn’t this been proven by hundreds of studies? Sadly this is not a joke as the article sites a study published in the most recent issue of the Journal of the American Medical Association entitled “Association Between Participation in a Multipayer Medical Home Intervention and Changes in Quality, Utilization, and Costs of Care”.

The authors of this study conclude; “A multipayer medical home pilot, in which participating practices adopted new structural capabilities and received NCQA certification, was associated with limited improvements in quality and was not associated with reductions in utilization of hospital, emergency department, or ambulatory care services or total costs over 3 years. These findings suggest that medical home interventions may need further refinement.”

More interesting is that the authors speculated that one reason for this lack of improvement was the fact that physicians in the study were rewarded for winning NCQA recognition rather than improved patient outcomes. Ya think? Now Diabetic Investor doesn’t want to say this study is yet another example of overstating the obvious but it is. Yet the fact that physicians weren’t rewarded for patient outcomes shows just how screwed up this Medical Home is. Listen up people it’s about time everyone learns that NCQA certification is nice and all but this isn’t about certifying the physician, this is about improving patient outcomes.

There is no need for Diabetic Investor to repeat what we all know; nearly two-thirds of all patients with diabetes are not achieving good control. That diabetes is not just a healthcare crisis but an economic crisis. That diabetes is a growing at epidemic rates across the globe. Diabetes is now the 8th leading killer in the US and unfortunately moving up the list. Diabetes also happens to be a disease with very clear and very measurable markers for success and/or failure. Put simply, we know when a patient is under good control and when there not. Put even more bluntly it would be pretty easy to incentivize a physician for producing better patient outcomes as the metrics for success are not subjective.

Honestly certifying physicians is like rewarding the captain of the Titanic a medal because he went down with the ship. Never mind that thousands of people needlessly lost their lives because the captain didn’t do his job. Nope let’s reward him because he did the honorable thing.

The time has come that everyone realizes when it comes to diabetes, a complex chronic disease; it’s not about the physician it’s about the patient. Physician’s that would be more proactive with their diabetic patients if they had a vested interest in patient outcomes. We don’t need a study to prove this; common sense tells us this is true. Yet common sense is in short supply in the wacky world of diabetes, sad but true.