We’re gonna make a bold statement: Moneyball by Michael Lewis is one of the best books of the 21st century. It’s all about how big data completely changed the game of baseball, foreshadowing the data-driven world in which we live today. You see, everyone in baseball was looking at the wrong stats in the wrong way. Batting average, RBI, and stolen bases lead to wins, right? Not exactly. By identifying unappreciated measures of performance, Billy Beane pulled off a playoff-caliber team at a fraction of the cost of his competitors. Let’s fast-forward to medicine--forever a decade behind the rest of planet Earth--where the past 5 years have been dominated by quality metrics. In our zealous push for quality-based care, we’ve created a dizzying number of physician performance measures without ever stopping to ask the actual quality of these metrics. A methodical approach to assessing the validity of the performance measures used in Medicare’s merit-based incentive program found only 37% to be valid. The two biggest problems were (1) measures supported by insufficient evidence and (2) poorly-specified outcomes of interest. TBL: Maybe this time next year we’ll have a physician scouting combine. | MacLean, N Engl J Med 2018


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