Measuring What Matters: Why Clinical Outcomes Must Reflect Action, Not Just Numbers
By Paul Soloviev
In my previous article, I argued that we must keep the fee-for-service model but rebuild it. We should fund continuity of care, reward good clinical management, and stop punishing clinics doing their best under challenging conditions.
But this raises a tricky question: How do we measure outcomes fairly?
Right now, there’s a dangerous trend toward measuring outcomes using patient targets—blood sugar levels, blood pressure readings, and cholesterol results. These might look neat on a government dashboard, but they’re the wrong indicators for funding general practice.
They don’t show effort or complexity, and worst of all, they punish clinics serving patients who need help most.
The Problem With Target-Based Outcome Measures
Let’s say a patient with poorly controlled diabetes comes to a GP in a low-SES suburb. The doctor measures their BSL, provides lifestyle advice, offers a referral to a dietitian, and adjusts the medication. The patient thanks them but doesn’t follow through. Life gets in the way: housing, income, family stress, or just burnout from years of illness.
Six months later, the BSL is still high.
Should this GP get paid less than a GP whose patients in a wealthy suburb follow every instruction to the letter?
Of course not.
But that’s precisely what happens when you tie funding to outcome figures instead of outcome actions.
What Should We Measure Instead?
We need a shift. We must measure—and reward—what was done, not just what changed.
Let’s base new item numbers around simple, verifiable actions:
- Was the patient’s blood pressure measured and recorded?
- Were pathology tests requested and results followed up?
- Was brief lifestyle counselling provided?
- Was a care plan developed or updated?
- Was a referral to allied health offered (not necessarily accepted)?
- Was smoking status assessed?
- Was mental health screening performed?
This is care. This is effort. This is what clinics can control.
‘We Did Do’ vs. ‘We Didn’t’
New item numbers must reflect a “we did do” approach rather than a “we didn’t” approach. It’s simple, fair, and transparent.
It removes the injustice of holding clinics responsible for things they can’t control—patient behaviour, social determinants, or sheer bad luck.
Instead, it allows Medicare to reward clinicians who take appropriate steps—consistently, thoroughly, and with a focus on prevention and long-term care.
This model encourages:
- Continuity of care is important because follow-up becomes fundable.
- Preventive care is important because checking and educating are billable.
- Chronic disease management is done because structured reviews are recognised.
- Team care is important because referrals and shared management are built in.
What Gets Measured Gets Done
Clinicians do what’s valued. And they stop doing what’s ignored.
If we want to lift the standard of care across Australia, we need to build item numbers that match the day-to-day work of general practice.
Not lab results.
Not wishful thinking.
But actual, measured actions that reflect good care in the real world—whether that’s in an inner-city superclinic or a small rural outpost.
Final Thought: You Can’t Incentivise Outcomes You Don’t Control
Let’s get back to basics. Good medicine isn’t about perfect numbers. It’s about consistently trying to help patients improve—even when the odds are stacked against them.
The new Medicare must be built on this understanding. If we want a stronger system, we must reward what matters. And what matters is what we do.
This is the fourth article from the ‘Medicare Politics’ series by Paul Soloviev.
Proposed 30% Medicare Rebate Increase Before the May 2025 Election: A Band-Aid on a Broken System, https://generalpracticetraining.com.au/proposed-30-medicare-rebate-increase-before-the-may-2025-election-a-band-aid-on-a-broken-system/
I Asked ChatGPT How to Fix the Medicare Crisis in Australia, https://generalpracticetraining.com.au/i-asked-chatgpt-how-to-fix-the-medicare-crisis-in-australia/
Capitation Model is Decapitation of Medicare, https://generalpracticetraining.com.au/capitation-model-is-de-capitation-of-medicare/
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