EP295: Surprising Insights About Measuring Primary Care Performance, With Rebecca Etz, PhD

In Episode 295, Stacey Richter talks with Rebecca Etz, PhD, associate professor of family medicine and co-director of The Larry A. Green Center, about surprising insights into how primary care performance should actually be measured. WHAT YOU'LL LEARN ✅ Why primary care remains one of the "best-kept secrets" of better health outcomes despite being chronically under-resourced ✅ Why measures that don't match the actual work of primary care are demoralizing to clinicians ✅ How financial incentives tied to the wrong targets distort what electronic medical records actually capture ✅ Why primary care is fundamentally a relational field, and what that means for measuring its value ✅ How primary care's performance measures held up during COVID, and where they broke down WHY THIS MATTERS Rebecca Etz and The Larry A. Green Center built 11 performance measures for primary care that are aligned across patients, clinicians, and payers — a rare feat, since PCPs already spend upwards of $40,000 a year of uncompensated time reconciling conflicting measurement standards. Etz argues that when the wrong things get measured, primary care's central strength — its relational, cognitive work of listening, thinking, and coordinating — gets systematically undervalued, and clinicians end up incentivized to paint an optimal picture in the record rather than actually deliver better care. MENTIONED IN THIS EPISODE 🔗 EP270, with Dave Chase 🔗 EP272, with Guy Culpepper, MD === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction. 03:41 Why is primary care one of the "best-kept secrets" of better health outcomes? 08:38 "Measures are a form of communication." 08:51 "If the way that you are assessed does not actually match up with the work you do or what you find to be important, it's pretty demoralizing." 11:41 "It is the outcome of health care, but it is not the same thing as quality." 16:31 "It creates a financial incentive to hit a target by any means necessary." 18:06 "We incentivize people to have good outcomes, and what that means is that electronic medical records are no longer simply databases that tell us what the health of the population is. They are databases that tell us what is the optimal picture that a clinician is able to paint of their patients." 21:07 "Primary care is a relational field." 22:14 "How does this relate to cost and utilization?" 26:43 "I think we all know that fee for service is death." 27:11 How has the measure of PCPs in the time of COVID held up? 27:32 What measure performs worse in the time of COVID? 28:17 "Primary care is the place that everybody goes." 31:16 EP270 with Dave Chase and EP272 with Guy Culpepper, MD.