How do we get it through to colleagues in cardiology and other specialties that "public reporting" on quality is not an option -- it’s already ineptly happening in multiple venues using claims and administrative data. Our polling indicates that most ACC members do not suffer from 'mural dyslexia' (the inability to see the handwriting on the wall), and see that public reporting on quality is a reality that we need to address head on.

If we are a profession, then society will rightfully expect us to be altruistic (patient centered), focused on assuring that our special expertise is based on valid data, and self regulation in terms of quality, ethics and accountability. Thus, we need to be the purveyors of the information that is publicly reported -- or we will dread what we see. What’s currently happening through CMS (PQRI), employer-insurer coalitions (Bridges to Excellence, PBGH, IHA, etc) and consumer groups needs major work to be valid. For large networks, we should work on using clinical data (like the National Cardiovascular Data Registry) to measure outcomes. At the individual doctor level, we may never be able to have a patient denominator and/or risk adjustment system sufficient to reasonably assess outcomes. But, we could assess the process measure of "adherence to guidelines and performance measures". Adherence to guidelines should not mean adherence to a cookbook approach to care, but rather to a 'learning system' of assuring that the best scientific evidence is applied to all clinical care -- and that when the guidelines typically do not apply 100% to the patient before us, that we take the time to report back as to why not. 

Health system reform will absolutely need to address physician and hospital payment reforms as a central part of delivery system reform and of essential quality and efficiency improvement. These are not issues that we can afford to delegate to non-clinicians to determine and oversee. These are our core responsibilities and accountabilities. I hope -- I pray -- we figure this out and step up to the challenge and opportunity here as a profession.

I guess the biggest challenge is: how do we reach out to our many colleagues who have their heads down taking care of patients, and don’t see the tsunami approaching?

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