As payers and regulators move to pay-for-performance systems, primary care practices are struggling to fit into a one-size-fits-all quality measures box, says one nurse practitioner.
“Quality measure reporting has become an assembly line or game, producing widgets or check marks to create profits, or keeping a scorecard that has little positive impact on patient outcomes,” writes Tom G. Bartol, a family nurse practitioner at the Richmond Area Health Center in Richmond, Maine, in a Medscape commentary.
As the government implements the Medicare Access and CHIP Reauthorization Act (MACRA), Bartol says it’s time to search for a better way to measure quality in primary care, which is a complex system with patients who have different backgrounds and needs.
But there is hope for relief on the horizon.
In March, the National Quality Forum’s Measure Applications Partnership said federal agencies should remove several healthcare performance measures.
MAP typically offers the Department of Health and Human Services new measures or improvements to consider adding to existing measures, but in last month's report the group took a look at older performance metrics to determine which ones the agency could potentially eliminate.
It suggested axing 51 of 240 measures that are included in seven federal programs used to determine payment. It also offered recommendations to improve performance measures in nine federal programs.
And in a report last fall, Johns Hopkins’ Armstrong Institute for Patient Safety and Quality made several suggestions to improve performance measurement. For example, policymakers should:
- Create one body that sets health standards. The authors suggest modeling this group after an organization like the Financial Accounting Standards Board, which is nonprofit and sets accounting standards for public companies. The proposed body should be independent and also set standards for how data used to determine performance measures is gathered.
- Make performance measures a science. Policymakers can push for funding to study the science of these markers, according to the report. They can also encourage collaboration between government agencies in this area and further promote efforts the Centers for Medicare & Medicaid Services has already undertaken.
- Make sure data is gathered effectively. With funding, policymakers can ensure research is done on how to best present information on quality and cost differences to patients.
Numerical quality metrics and quality reporting contribute to burnout among clinicians, Bartol noted in the Medscape piece. It’s hard to make human factors and priorities, as well as patient goals, attitudes and beliefs, fit into guidelines that measure individual elements of the system.
It would be better, he added, to measure outcomes than processes, since factors such as clinician/patient continuity and spending increased time with patients with complex problems are quality measures that do improve care and reduce costs.