As a family doctor I am constantly being measured by HEDIS criteria and compared to my peers' average measures. This is how I am graded by most of the health insurers I contract with and my pay for performance (P4P) dollars are often based upon them. Yet, no matter how much my patients prefer – after careful, physician-delivered full disclosure of why this should be done - not to have a colonoscopy, not to schedule a diabetic eye examination or not to take a statin for coronary artery disease, it is the physician who is penalized for not obtaining one. When charts are reviewed, and documentation is read, informed choice is not a consideration for HEDIS.
In my opinion, HEDIS criteria are unreasonable, static, inflexible and fail to account for patient preferences. It measures physicians by the same unforgiving yardstick that expects all patients to be the same. It fails to account for the degree of patient preference care that’s been described in other care settings in the Dartmouth Atlas.
The only way to incorporate flexibility of choice in the P4P system is through the use of multiple individualized clinical pathways. Yet, each of the multiple clinical pathways are also inflexible and ill-suited to the special circumstances of each patient. Here’s the conundrum: If I am offering flexibility to my patients through multiple inflexible options, how can I properly inform them flexibly?
The DMCB doubts managed care medical directors will care much about this point of view, partially because they've been brainwashed by regular attendance at the Church of the Holy HEDIS and partially because their bonuses often depend on it.