From the PCD Partners Blog: Featured Post

Perverse Incentives, Clumsy Laws, and the Value/Volume & RVU Conundrum in Medical Quality

The largest single problem with flow-based quality concepts in medicine is that neither patients nor providers consider process quality measures to be relevant to their personal concept of quality. Instead, they focus on the practical concepts of provider skill and experience – the results of constant training and procedure volume. On the other hand, doctors and hospitals are paid according to Relative Value Units (RVUs), which have nothing to do with volume, experience, or the resulting improvements in quality. Instead, RVUs create a system where specialized procedures are paid far more highly than primary care. This lures many struggling hospitals into offering high RVU procedures, regardless of their ability to attract sufficient patient volume to develop the experience and skill required for a high quality outcome. Legal restrictions on referrals compact the problem by blocking the ability of smaller hospitals to direct patients to high-volume centers without losing all of the potential revenue. To achieve an acceptable level of quality improvement in healthcare, we must first find a solution to this value/volume conundrum. ... more »