Sabbatical by bicycle: A healthcare listening tour across America

Oct. 14, 2019 / By L. Gordon Moore, MD

Dr. Paul Gordon rode a bicycle across the U.S. in 2016 asking people their thoughts on the Affordable Care Act. It was a true listening tour and he was not using the question as a way to shift opinions. I heard him speak as part of a panel presentation at the 50^th anniversary of the Family Medicine residency in Rochester, NY and was interested in his “person-on-the-street” approach to exploring healthcare policy.

I suspect most people see healthcare policy as some vague threat to make a mess of the health care we want—policy seems to happen behind closed doors and in back rooms. But ultimately, healthcare policy should embody the wishes and aspirations of our society. 

Healthcare policies may have good intentions, but sometimes they result in consequences that are opposite of the intent of the policymakers and the public. Measuring quality comes to mind as an example.

We want good health outcomes when we pay for health care. Measuring outcomes is hard, so we tend to measure structure and process that we believe are likely to lead to good outcomes: The structural presence of Computer Physician Order Entry software should reduce medication order errors, so a hospital with CPOE gets quality points. People with diabetes should manage their blood sugar, so the frequency of testing for blood sugar in diabetes becomes a process measure for quality. This approach is less than ideal as the structure of CPOE may be implemented badly, process metrics may not actually result in outcomes improvement, and all we’ve done is to add costs to healthcare delivery and divert doctor and nurse time away from patients to focus on measurement compliance.

Here’s a link to a nice article describing the gap between the aspirational label “Center of Excellence” and outcomes about which we care deeply (like potentially preventable complications and mortality). The authors do a good job of unpacking the problem with measuring structure and process and thinking that tracking these measurements should automatically translate to outcomes.

Back to Paul Gordon. He rode across the U.S. asking people to describe their thoughts on the ACA. It is important that we understand the intersection of policy and things that matter in our work and lives. He describes his journey and talks about his next one on our Inside Angle podcast.

L. Gordon Moore, MD, is Senior Medical Director, Clinical Strategy and Value-based Care for 3M Health Information Systems.