Gaming the System: Graduation Rates & Pneumonia Rates
Regular readers of the blog will know that one of my favorite topics is “Gaming the Numbers” (or “Gaming the System“).
As Brian Joiner so brilliantly wrote, as shared by the late, great Peter Scholtes , there are three things people can do when faced with having to hit goals, targets, or quotas:
(1) improve the system, (2) distort the numbers, or (3) distort the system
Two items were in the news recently about #2 and #3 — from NCAA basketball and from hospitals.
Kentucky head basketball coach John Calipari seems like the type of coach I'd dislike… a coach who is basically perpetuating a system of “pre-professional” players in a game that's supposed to be for “student-athletes.”
He was on ESPN recently, plugging his new book and he said some things that actually made me think of Kaizen and Lean leadership. He talked about how important it was to continually practice and to, through the course of a season, figure out the best way to incorporate different players into a system that works. It sounded like a PDSA process where they figure things out experimentally rather than just relying on throwing a bunch of individually talented people into the mix.
But, there was a story that surfaced during the NCAA Tournament that raises an ethical question – is Coach Cal distorting the system and just doing what's needed to hit a goal set by his organization, or is this dishonest?
As reported by ESPN's Darren Rovell:
Calipari used to get a $50K bonus if 75% of his senior class graduated. Often had 1 senior. UK deleted clause in 2011. (tweet)
As long as Calipari had a graduation bonus he was incentivized to always have a walk-on senior. Easy $. School realized it. (tweet)
Kentucky is known as a “one and done” school, where basketball players often just play the one season that then allows them to declare for the NBA draft. Most players don't stay all four years.
I guess 75% of zero wouldn't count toward that $50,000 bonus. So, the easy way to “game the system” is to invite a walk-on (non scholarship) player onto the team (one you know is going to graduate) and then the graduation rate was one of one or 100% –> bonus!
How'd you like to be that player who realizes that your coach is making $50,000 off of you? I'm glad Kentucky changed that bonus clause.
Gaming the VAP Numbers
I think it's generally a good trend that CMS and others are no longer paying hospitals for so-called “never events.” It's a clumsy mechanism, but the dysfunctions caused by the incentive of NOT paying for those preventable cases of patient harm is probably less than the dysfunction of the old system where hospitals got paid for the care provided to treat those preventable errors.
From the WSJ and a letter to the editor (not sure if it's behind the paywall):
The ACA inserted an economic bias when the incidence of a VAP rate was considered a quality outcome measure and could, if implemented, adversely affect a hospital's reimbursement rates. Physicians, aware of this have subtly altered the terminology for coding, substituting, for example, a diagnosis of tracheobronchitis for ventilator-associated pneumonia.
As they say, if it's easier (or perceived as easier) to distort the system than it is to IMPROVE the system… then apparently you get distortion and gaming instead of improvement.