Money vs. the means to do a good job
Written by Ardena L. Flippin, MD, MBA   

Last month's commentary on physician pay-for-performance generated some interest - and is related to an article in the month's JAMA, which has received a lot of attention. The issue of the May 14 2008 JAMA, "Comparison of Change in Quality of Care Between Safety-Net and Non-Safety-Net Hospitals", commented on the "smaller gains (of safety-net hospitals) in quality performance measures over 3 years (compared to non-safety-net hospitals.) I’m not surprised that pay-for-performance doesn’t necessarily improve quality at safety-net hospitals. When will we ever admit that throwing money at a systemic problem is not the answer? What a passé cop-out in the 21st century!

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A key phrase in the JAMA article, "Care for poor and underserved patients in the United States is currently concentrated at a small number of hospitals…." reflects the state of healthcare in the United States, and the fact that our "system" of health care is to accept that the poor and underserved are segregated from mainstream (quality) healthcare. So if accept the premise of an unleveled playing field, or starting behind the starting line or whatever analogy one wants to imagine, what does the "carrot" of money really mean? If we don’t accept the premise of the haves and have-nots being entitled to different sources of care, then we are faced with developing a real "system" of care – and there’s the rub. It’s simply easier to throw money at a situation than to do the really hard work of scrutiny and revision.

Someone recently told me that the newer concepts in change are not simply to make money, but rather to "make money and meaning"…"to be proud of achievements and accomplishments". The ways or means to imbue "meaning" to healthcare are not easily determined, in fact, it can be vague and this is why it is easier to use solely money to solve the issue of quality.

Many years ago I attended a quality improvement seminar, and the last statement of the day emphasized that, "He who has the Data, has the Power." I believe that an approach to improving quality is to use the data to communicate to and educate physician and hospital health care providers.

The entire healthcare industry is getting a bad rap right now. Give our industry credit for being more than money-driven. Give healthcare providers (hospitals, physicians, nurses, pharmacists and allied health professionals) credit for wanting to improve and deliver quality care for the sake of personal and collective development and personal and collective achievement.


May 14 2008 JAMA, "Comparison of Change in Quality of Care Between Safety-Net and Non-Safety-Net Hospitals".

About the Author

Dr. Ardena Flippin

Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County Hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital.

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