The Parable of an Insurance Company's Perfect Physician
Megalopolis Health Insurance (MHI) was searching long and wide for the physician who met their platonic ideal of what a doctor should be. They found just such a physician, named Doctor Donoharm. Dr. Donoharm was perfect on all measures that insurance companies crave on their quality metrics in the past year.
MHI started using Patient Satisfaction surveys as a measure of quality. Dr. Donoharm was a model of perfection- zero patient complaints for the entire year!
MHI took to heart the Institute of Medicine's To Err is Human report that attributed between 44- 98,000 patient deaths to physician error. MHI recognized that the best way to save lives was minimizing physician error! What a scourge! And lo and behold, Dr. Donoharm had the lowest rate of physician error of any contracted physician. In fact, Dr. Donoharm had no physician errors for an entire year!
MHI also realized that they could help stamp out the cost of physician over-utilization of resources. At MHI Headquarters, they lived by the mantra "the most expensive tool is a physician's pen", and they were going to create a series of incentive systems to prevent physicians from over-ordering expensive tests. They would follow the recommendations of the American Board of Internal Medicine's Choosing Wisely campaign to prevent unneeded tests like MRIs and expensive lab tests. And when MHI executives looked to see who their #1 physician in terms of avoid over-utilization was for the past year, it was yet again Dr. Donoharm.
It was clear to MHI executives they had finally found the perfect physician. No complaints! No deaths attributable to physician error! No unneeded tests!
MHI decided to pay a visit to Dr. Donoharm to see how they could teach other doctors act to model themselves. The secret?
Dr. Donoharm died a year earlier, and stopped seeing patients.
The morals of this tale:
1. From the standpoint of an insurance company, the best physician is a physician who doesn't actually see patients. They don't actually have to be dead (although, from the insurance companies standpoint, that's also one less patient to treat)
2. When an insurance company uses the word quality, what they really mean is cost containment
3. When an insurance company says they are saving costs, what they really mean is that they are increasing their profits
4. If you want to know if a doctor is a good, the quality metrics used by insurance companies and central health systems will confusing at best.