The Healthcare Metrics Puzzle


Everyone has a metric.

HCAHPS, CG-CAHPS, Medicare, PQRS, patient safety, patient satisfaction, physician satisfaction, appropriateness criteria, relative value unit, salary structure, and more.


The challenge with the majority of the metrics in healthcare is alignment. The stakeholders are not aligned. They way physicians and caregivers are paid is not aligned with payments. They way reimbursement is decided is not aligned with how physicians and caregivers work. The inclusion of patients is not aligned with how reimbursement is decided or how physicians and caregivers do their work.

Therefore, stakeholders are forced to make a puzzle as complete as possible without using all of the pieces. Since we are human, we choose the biggest pieces to make the puzzle that most benefits us.

I believe there are only 2 metrics that matter in healthcare today: why and what.

Why do I feel like this?

What options do I have to make me feel better?

The why question usually begins with primary care, family medicine, pediatrician, internal medicine, or the emergency room. Yet the ones who typically provide the answers to the “why” question are pathologists and radiologists.

In my experience I engage the various stakeholders and demonstrate how working together as a team, that encourages constructive conflict, allows everyone to do the work they enjoy while providing the right answer, at the right time, to the right patient. A team providing a diagnosis.

The what question answer(s) can be simplistic to complex.

It could be a primary care physician discussing an antibiotic, prescribing the medication, instructions being reiterated by a pharmacist, and a nurse following up in a few days.

It could also mean a team of physicians discussing the complexity of a patients care due to congestive heart failure, while having diabetes, and being newly diagnosed for cancer. It takes a diverse team to have an open discussion on what the best option for treatment may be, while also discussing the other options of no treatment, or treating some ailments but not all. It takes coordination to transition the information and have a transparent conversation with the patient on their options.

In my experience, when we openly discuss the treatment options among stakeholders, we become aligned to answering the what question for patients.

Safety, satisfaction, outcomes, cost, efficiency, efficacy, wait times, appropriateness criteria, radiation dose, relative value unit, and reimbursement are all metrics.

Patients, Physicians, Payers, Politicians, and Pharma all play the metrics game to their own advantage.

They race to grab the most pieces. Yet none of them have all of the pieces to complete the puzzle.

The stakeholders believe they are trying to complete a 1000 piece puzzle.

I believe the puzzle consists of only 2 pieces….

One piece for why, the second piece for what.

When you step away from the puzzle you will notice that the picture is simple:

Norman Rockwell Image

I do the work that matters.

As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek



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