JUDGING THE QUALITY OF QUALITY MEASURES

By the end of 2018, the Centers for Medicare and Medicaid Services (CMS) intends to tie 90% of payments to Medicare fee-for-service clinicians to their performance on quality measures. The Merit-Based Incentive Payment System (MIPS) consists of 271 such measures which were designed to provide an objective yardstick to identify and financially reward those physicians who provide the highest quality care to their patients.

To ensure that they are able to participate in these incentive programs, which can result in the highest-performing clinicians receiving up to 9% more than their lowest-performing peers, physicians are neck-deep in data collection and reporting. Oftentimes they must create policies and procedures to ensure consistent compliance with the standards. But how reliable are these measures in identifying true best practices, and how much do they correlate with desirable outcomes?

To answer this question, a team of researchers from various institutions, including the Hospital for Special Surgery in New York; the University of Michigan and the Veterans Affairs Ann Arbor Center for Clinical Management and Research; and the American College of Physicians assessed the validity of 86 of the 271 MIPS performance measures. Their results were published in the April 18, 2018 issue of the Journal of the American Medical Association (JAMA).

Of the 86 measures examined, only 37% were determined to be valid, according to the methodology used. More than one-third were deemed not valid, and the validity of the remaining 28% could not be determined.

This begs several questions: Why are physicians being rushed to implement data collection and reporting on metrics of questionable clinical value? Will these incentive programs truly achieve the objective of improving quality of care? How will adding layers of administrative work to an already overworked physician result in lower healthcare costs?

Whether or not the desired outcomes will be attained, we have observed some unintended consequences. Many independent physicians are electing to sell, merge or close their practices as the burden of data collection becomes unsustainable. What are your thoughts? How have these program requirements affected you? What do you think of this study?

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