At the same time, Goodman and his co-authors agree that performance measures need to be refined. In the JAMA paper, they argue that Medicare should encourage hospitals to "invest in broader goals and should reward success."
For example, they suggest that readmissions reduction programs should consider admissions as well because many of the behaviors that lead to unnecessary admissions also lead to readmissions. They cite a program that targeted care transitions in 14 communities in an effort to reduce readmissions. The per capita rate of both admissions and readmissions declined when the hospital worked with community providers to improve the coordination of primary care.
"This unexpected result—a positive variation on the law of unintended consequences—teaches an important lesson: targeting the performance of one medical care service can change a behavior that can affect the performance of other services," they wrote.
They key, Goodman says, is to develop performance measures that reflect what's most important for patients and their care.
"Performance measures are sometimes a compromise between what is important and what can be measured," he said. "The need to pay for quality and outcomes is important. It is hard work to get the measures and the incentives right. We're not there yet. But we need to continue on that path."