HLM:Jeff Immelt, the CEO of GE was quoted recently as saying he had never seen an industry with so many measures that didn't matter. That gets to my question of quality measures. People are complaining, even in Congress, that there are too many of them. How do you respond to those concerns?
Mostashari: Patrick Conway and Carolyn Clancy and I wrote an article in JAMA which talked about, [and] I hope, laid out that vision for where we need to go in quality measurement. I would agree that there are a lot of legacy measures that don't really matter that much.
Part of what we laid out in the paper is [that] we need to move towards measures that matter, towards measures that are more for accountability purposes, more outcomes-oriented, and more parsimonious, more broad-based and parsimonious.
So if we have a thousand measures, [and] they're all about clinical processes for each different specialty, a chicken in every pot, well that's okay. But we should also have measures that apply to anyone who writes a prescription. A measure around medication safety and safe prescribing would apply to them, and we don't have a very good measure for that.
Anyone who gets a referral or sends a referral should be judged on the basis of how well they close that loop. And there were no measures for closing the referral loop until we worked with CMS to develop them for Stage 2 of Meaningful Use.
I mentioned medication safety. There was exactly one measure. I wouldn't say we had too many measures for medication safety. There was exactly one measure for safe prescribing. It was safe prescribing in the elderly, and there was a list of 100-plus medications that quote unquote elderly patients shouldn't be prescribed.