The Tyranny of Metrics

by Jerry Z. Muller

Just how costly and burdensome the pursuit of ever more medical metrics has become is evident in a recent report from the Institute of Medicine.28 At major medical centers, the cost of reporting quality measures to government regulators and insurers amounted to 1 percent of net revenue. Administrative costs for measurement and related activities are estimated at $190 billion per year. Then there is the unmeasureable cost of providers entering data into the government’s Patient Quality Reporting Systems. Larger medical practices must pay external firms to enter the data; in smaller practices, it is sometimes left to the physicians themselves. In addition to the tangible costs of gathering, inputting, and processing this tsunami of data, there are the incalculable opportunity costs of what doctors and other clinicians might have done with the time they must devote to inputting data. Moreover, the time invested is largely uncalculated and uncompensated. It typically falls out of consideration when medical costs are discussed.