Among physicians these days, introducing the subject of quality and the entity known as the quality movement is a bit like talking about U.S. politics: There are a wide range of views. When the subject of quality is raised, there are the “true believers” who think the quality movement is the only option to standardize and improve medical care in the United States while addressing the reality of spiraling healthcare costs, and there are the “hard skeptics” who are convinced that the quality movement is just another scheme to squeeze more out of already embattled clinicians and restrict treatment options to the cheapest alternatives. Many members fall somewhere between the two ends of the spectrum.
A recent poll of ACR members on the quality movement found that these broad views are reflected by our membership. It’s not difficult to see why some physicians would be skeptical. The worthwhile aims of the quality movement may appear at odds with those of its big endorsers such as the Centers for Medicare and Medicaid Services and private insurance—especially from the perspective of a community-based, small-practice clinician. Invariably, among clinicians, the discussion turns to pay-for-performance (P4P) and horror stories of incentive systems that mutated into penalty systems based on arbitrary assessments of “quality of care.”