About half of U.S. MDs, and many nurse practitioners andphysician assistants, wish their field could go back in time,before the advent of quality metrics and penalties for failure tomeet certain national standards.


With the medical industry coming under increasing scrutiny forquality and cost performance, The Commonwealth Fund and the KaiserFamily Foundation decided to ask the caregivers what they thoughtabout such matters. They were also asked whether advances in ITservices made their jobs better or worse.


The study reported was divided into two categories: responses byphysicians and the combined responses of nursepractitioners and physician assistants, despite the fact that thetraining received by NPs and PAs, and their job descriptions, arequite different from one another.


Here are some of the major findings of the study:

  • 50 percent of primary care physicians say the increased use ofquality metrics to assess provider performance is having a negativeimpact on quality of care, and 22 percent say it has a positiveimpact. Others either aren't sure or say it has no impact.

  • 38 percent of NP and PA respondents cited metrics as a negative,and 27 percent as a positive.

  • 52 percent of physicians say programs that impose financialpenalties for unnecessary hospital admissions or readmissions arehaving a negative effect on quality of care, while 12 percent said such programshave a positive effect.

  • 41 percent of nurse practitioners and physician assistants saidpenalties have a negative effect on their practice; 15 percent saidit was positive.

  • 50 percent of physicians said IT advances have had a positiveeffect on their practice; 28 percent said it was a negative.

  • 64 percent of NP and PA respondents cited IT advances as apositive, with 20 percent saying it had negative effects on thepractice.

  • Physicians viewed the increasing role of nurse practitioners andphysician assistants as a negative trend in the industry.Meanwhile, NP and PA responses indicated they view this newcollaborative trend much more positively.

  • 55 percent of primary care physicians reported receivingfinancial incentives based on quality or efficiency measures, whichthe study authors called “an indication of the reach of ongoingefforts by public and private payers to reward providers forquality of care rather than for the amount of services delivered topatients.”

But these emerging trends aren't sitting well with many of thenation's primary caregivers, and early retirement now seemslike a good idea to many. Some 47 percent of physicians and 27percent of nurse practitioners and physician assistants agreed thatthey are considering retiring early as a result of the new paradigmin medical care.

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