I presented the ACC “Quality First” vision to an Institute of Medicine audience recently, and discussed how the NCDR® could be a prototype means of physician-directed, patient-focused quality reporting. This type of reporting could benefit Medicare, insurers, physician recertification and continuous quality improvement systems used by practices.

The issue of individual physician outcomes reporting was on the agenda as well. I questioned the validity of individual outcomes reports for non-procedural diagnoses, and even for many procedures (unless individual physician measurement were to be focused on adherence to guidelines and performance measures.  That could work).

The ultimate policy debate, it seems, is about the dichotomy between physician autonomy and systems of quality care. The big questions are: what do we believe in; and what is best for patients? Could it be that, within physician-directed systems of care, autonomy is the force of creative change? That in following systems of care, but preserving the autonomy to reject a guideline or performance measure for an individual patient’s benefit, all of medicine continues to learn, innovate and progress? (OK, then, too much coffee?)    

But, there’s a lot of interest in what the College is trying to create in these regards through the NCDR® and the Quality First campaign. It’s "catching on." But there’s no time to waste. We need the IC3 ambulatory registry to succeed to make this dream come true, folks. And a little luck.