What Gets Measured Gets Managed: The Case for Bypassing Notice-and-Comment Rulemaking for Measure Maintenance

By Ashley Liu. 

Suppose that Aaron is an ophthalmologist who lives and works in the San Francisco Bay Area. In his flourishing private practice, Aaron mostly performs routine cataract surgeries. This is perhaps unsurprising, as cataract extractions are some of the most commonly performed surgical procedures. For every cataract surgery, Aaron always follows a detailed checklist and has at least one assisting staff member.

Now, suppose that Daniel is another ophthalmologist who lives in relatively rural Amherst, Massachusetts. Daniel does not employ any nurses or anesthesiologists; he operates alone. Also, because Daniel performs cataract surgeries significantly less often than Aaron, he has no standardized operating procedures.

Aaron and Daniel both make a living by performing the same twenty- minute cataract extraction procedure, but they vary dramatically in how they do so. Similar variation occurs among cataract surgeons across the country and the rest of the world. For such a prevalent operation, there is a serious lack of consensus on what surgical procedures should be followed. Full Article.