Please explain the value of "metrics" in anesthesia to me

[aneftp]

See all these BS "metrics" crap anesthesia groups and companies try to show to hospitals.

What is the actual value of achieving some of these metrics (aka giving 10 mg of esmolol which lasts 10 minutes will fulfill a beta blocker "metric").

Or a triple AAA bleeding patient brought into Or with BPs in the 50s and failure to give antibiotics within the first hour cause the surgeon and anesthesiologist are trying their hardest to keep the patient alive first and foremost.

To me there are very few "metrics" in anesthesia that are dependent on anesthesia itself.

All the others (time in OR, PACU discharge time have way too many variables).

We've seen the VA scandal in Phoenix with that administration fudging the "metrics" about schedule patients within a reasonable time. The lied. We all can lie. Especially if nurse, anesthesia and surgeon are all in agreement the in OR room time was 730AM. Even though it was really 734AM.

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[OB1🤙]

The Nurses With Clipboards are hungry for boxes to check, and they need to be fed.

 

[deleted171991]

Nurses With Clipboards is an umbrella-term for organizations like CMS, JCAHO, Magnet and other useless money-pits.

Meeting most of these "metrics" increases the hospital's reimbursement by a few percentage points. We live in an era when hospitals have to waste so much money on the indigent that those few percentage points of extra reimbursements make all the difference between a hospital being profitable or going bankrupt.

For example, the 7:30 start is a Medicare "quality" measure, AFAIK. Excuse me? Does anybody measure all the time those bureaucrats are wasting every day?

Same goes for the pre-op antibiotics, beta-blockers, post-op temperature in the PACU.

 

[Planktonmd]

These metrics are designed to look good on paper no matter how crappy the patient care and the outcomes are.
For example if you literally kill a patient (failure to recognize esophageal intubation, medication error, causing an air embolus...) but you have given the antibiotic on time, you used a forced warm air blanket and placed the central line following all the holy rituals, you are 100% compliant with PQRS and you will get more money!
The fact that your care resulted in the patient's death is irrelevant as long as the chart is buffed and these three things are documented.

 

[nimbus]

PQRS metrics serve as surrogate markers of quality because they are easy to measure and easy to document.

Actual quality is much more labor intensive and difficult to measure and quantize, but we all know it when we see it. Quality surgeon vs crappy surgeon? Good resident vs bad resident? Who's slick and who makes a bloody mess of every procedure. Whose blocks work every time? Those are no brainer examples.

It is ironic that the method we use to measure quality is of horrible quality.

 

[Spinach Dip]

Metrics give pencil pushers and petty bureaucrats a job to do.

Therefore, they are good things. Think of all the middle-managers who would be unemployed without them!

 

[IlDestriero]

The only metric I care about is units.

 

[aneftp]

Has anyone made a point to challenge these metrics?

The added costs (more time devoted both for anesthesia peeps) along with hiring more staff to analyze these pointless metrics?

If it costs more money to analyze these idiotic "measures of quality" with very little clinical outcome improvement than they need to be eliminated for the sake for cost savings. That would be the ironic outcomes. Eliminating these dumb metric measures that people are required to report and than get analyzed would lead to greater cost savings by eliminating of staff needed for this unnecessary overhead.

 

[deleted171991]

There was a guy call Ioanidis who kind of proved that most of our precious research is bull feces. What was the result? We publish even more bull feces.

One cannot fight the onslaught of selfish human stupidity. The academics cannot accept that the crap they publish is mostly useless, when exactly that crap is used as criteria for promotions. It's not only the bean counters; it's (some of) us.

 

[Planktonmd]

There was a guy call Ioanidis who kind of proved that most of our precious research is bull feces. What was the result? We publish even more bull feces.

One cannot fight the onslaught of selfish human stupidity. The academics cannot accept that the crap they publish is mostly useless, when exactly that crap is used as criteria for promotions. It's not only the bean counters; it's (some of) us.

Exactly!
Most of the crap that is "anesthesia literature" is absolutely useless and masturbatory and that's why people tend to relearn anesthesia after they finish residency.

 

[deleted171991]

The Dark Side of Quality - a very good article about our useless metrics

This is the introduction:

Nobody stands up to argue against quality and value in healthcare. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators like The Joint Commission, or (worse) by the government.

There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict of interest, or outright fraudulent. Any experienced physician knows that there are fads in healthcare just as there are in fashion, and today’s evidence-based medicine may be tomorrow’s malpractice. Let’s take a closer look at what’s really going on in the world of quality metrics, and why it matters if payments to you and your hospital are increasingly linked to how you score.

And here's one of the conclusions:

Unfortunately, the direction CMS is taking—led by a nurse (Marilyn Tavenner) rather than a physician—lacks any semblance of scientific rigor and prudence. The “value-based” system will increasingly link payments made to physicians and hospitals with patient satisfaction scores. While this may appeal to consumer advocates, the fact is that the delivery of medical care is not like running a restaurant, and the customer is not always right. A 2013 study in JAMA Internal Medicine reported that patient preferences for shared decision-making were associated with longer inpatient stays and with 6% higher total hospitalization costs.(19) Dr. Frederick Greene, a nationally recognized general surgeon, wrote recently, “We have all experienced patients who demand certain drugs, imaging studies, surgical procedures and home care strategies that may be unwarranted, unhelpful or downright wrong!” Physician pay should not be tied to Press Ganey scores, Dr. Greene argued. “The only winners in this game of linking pay to patient satisfaction are the entities created to measure and promulgate these highly suspect data.”(20)

 

[BuzzPhreed]

For example, the 7:30 start is a Medicare "quality" measure, AFAIK. Excuse me?

Are you sure? I wasn't aware of this. Linky?

Does anybody measure all the time those bureaucrats are wasting every day?

It's a vast conspiracy to keep people employed. That's the true "big lie" about Obama/ACA. They have zero concern about actually improving the system because they don't actually understand it. They just want to create jobs. You have to understand how something works and whats actually important before you can fix it. The whole SCIP measures have been proven repeatedly to be mostly bogus.

 

[wee eng]

See all these BS "metrics" crap anesthesia groups and companies try to show to hospitals.

What is the actual value of achieving some of these metrics (aka giving 10 mg of esmolol which lasts 10 minutes will fulfill a beta blocker "metric").

Or a triple AAA bleeding patient brought into Or with BPs in the 50s and failure to give antibiotics within the first hour cause the surgeon and anesthesiologist are trying their hardest to keep the patient alive first and foremost.

To me there are very few "metrics" in anesthesia that are dependent on anesthesia itself.

All the others (time in OR, PACU discharge time have way too many variables).

We've seen the VA scandal in Phoenix with that administration fudging the "metrics" about schedule patients within a reasonable time. The lied. We all can lie. Especially if nurse, anesthesia and surgeon are all in agreement the in OR room time was 730AM. Even though it was really 734AM.

Because quality is hard to agree on and difficult to measure, organizations and anesthesia groups use metrics as a 'substitute' for measuring quality. You can use them to your advantage in negotiations... for example, using a list of easily achievable metrics as a trigger for compensation or bonuses... or they can be used against you. It is maddening to know that most administrators, insurance companies, and reviewers do not probably even understand the metrics, let alone why they are only proxies for actual quality. Having said that, the "metric system" is here to stay because it provides the illusion of measuring the unmeasurable.

 

[aneftp]

Because quality is hard to agree on and difficult to measure, organizations and anesthesia groups use metrics as a 'substitute' for measuring quality. You can use them to your advantage in negotiations... for example, using a list of easily achievable metrics as a trigger for compensation or bonuses... or they can be used against you. It is maddening to know that most administrators, insurance companies, and reviewers do not probably even understand the metrics, let alone why they are only proxies for actual quality. Having said that, the "metric system" is here to stay because it provides the illusion of measuring the unmeasurable.

Agree. Why is the Asa (and even the aana) fighting this

If there is no improvement in outcome than it becomes a cost issue. Simply a waste of money.

Wouldn't it be ironic to prove these metrics themselves that's suppose to improve quality don't and simply add to the overall cost of health care?

 

[BuzzPhreed]

I was just chairing a meeting for a subspecialty committee in our hospital the other day (substituting for someone who couldn't make it). I am well-known and knew all the players at this meeting. There were some serious issues to address but the first 20 minutes (of a halfhour meeting) was taken up by the 'utlitization nurse' who presented all manner of data related to SCIP, HCAHPs, etc. etc. It was a complete waste of time because our denominators are so small at our hospital for many of these benchmarks. It is utterly arbitrary some of what happens and one bad outcome in a month can totally skew the whole report because of some of our low numbers in these things.

I'll say it again that I think this is a conspiracy to create jobs and keep people employed. Some of the benchmarks we missed didn't ultimately affect the patients outcome. It was just something black and white to measure and either pat ourselves on the back or frownie face if we didn't meet them. It had nothing to do with ultimately what happened to those patients.