Family Medicine: Balancing Quality Care and Data

Analytics has finally made its way to family medicine. Thanks to the heavy focus now being placed on quality-based care as opposed to fee-for-service medicine, more and more family practitioners are finding they have to rely more on big data for many of the decisions that keep a daily practice running and insurance companies at bay. Family medicine in the era of analytics is quite the balancing act.

Underscoring the challenges today’s family practitioners face is an insightful article published by the American Academy of Family Physicians in mid-July. The article was written by contributor Dr. Ryan Neuhofel, an eight-year family medicine practitioner.

The premise of Neuhofel’s piece is physician motivation. He makes the case that a genuine desire to help people is still a more motivating factor than the financial incentives that come with being a doctor. As such, he finds the current value-based medicine model somewhat flawed in that it ties reimbursement rates to perceived quality. His thinking is that the current model relies too much on data and analytics to determine quality, thus driving doctors to make decisions that might be contrary to that desire to help patients.

Trying to Improve a Broken System

In fairness, the entire point of value-based medicine is to fix a system that is clearly broken. Although the fee-for-service model has been around for decades, it is a system that allows doctors and healthcare facilities to charge for services whether these actually do any good or not. This also runs counter to the doctor’s inherent desire to help people. No incentive to pursue treatments that work give doctors a reason to go along with whatever health insurance companies want.

Neuhofel has observed this sort of thing firsthand. He mentions in his article how he routinely sees “blatantly poor medical care in the history of…new patients.” He addressed unwarranted medications and tests alongside more important things that doctors fail to address.

The challenges of the system are equally persistent across the family medicine field. Practice owners face them; locum tenens doctors face them; even employed doctors who work for groups or hospital-owned practices face them. They are the challenges that come with balancing quality care and data while remaining true to the primary motivation of wanting to help patients live healthier lives.

A Time for Non-Standard Care

Balancing quality care and data in a family medicine setting is most difficult when it comes time for non-standard care. Neuhofel cites a surprising study published in the New England Journal of Medicine that shows that only about 37% of the data metrics now used by family physicians to make quality care decisions are valid. The rest have never been validated as being in any way useful to making good health care decisions.

The interesting thing about family medicine is that doctors tend to build strong relationships with their patients over many, many years. A good family practice doctor sees multiple generations of the same family over a career. What that doctor knows about the various family members will generally play a stronger role in the decision-making process than raw data. So when analytics and metrics throw a monkey wrench into the decision-making process, what is the doctor to do?

It is clear that we have to make the most of the new value-based system of medicine. It is here to stay. So family physicians – be they practice owners, employed doctors, or locum tenens – have to find a way to reconcile the natural desire to help patients against the financial realities of modern medicine. That is just the way it is.

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