To try to address this gap, I set up a meeting with midlevel Medicare leaders. They liked the idea of setting boundaries of acceptable variation. They referred me to their website, which lays out their standard process for proposing a new quality measure for Medicare to consider using. I noticed that one of the requirements was that any proposed new measure be supported with multiple published articles proving that the measure was evidence-based. That’s a nice idea, but a narrow way to look at quality improvement. No one would ever do a trial comparing the outcomes of surgeons who take two
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When governance goes wrong!
