Study Questions Effectiveness of Performance Measures
A study published in the New England Journal of Medicine asserts that the U.S. healthcare system does a poor job of measuring quality. The study’s researchers led by lead author Catherine McLean, MD, PHD, chief value medical officer, Hospital for Special Surgery, recommend that organizations should stop using performance measures until they can be assessed and revised.
The study notes that a recent survey found that 63% of physicians said that current performance measures do not capture the quality of the care physicians provide. The Performance Measurement Committee (PMC) of the American College of Physicians (ACP) had developed criteria to assess the validity of performance measures. McLean and researchers applied the ACP criteria to the measures included in the Medicare Merit-based Incentive Payment System (MIPS)/ Quality Payment Program (QPP), hypothesized that if most of the MIPS/QPP measures assessed were deemed valid using this process, physicians would have more confidence in using them to improve patient outcomes.
In this study, the researchers identified and rated the validity of 86 measures on the 2017 QPP list that were considered relevant to ambulatory general internal medicine. Of those, 32 (37%) were rated as valid by this method, 30 (35%) were found to be not valid, and 24 (28%) were of uncertain validity. For each measure, the committee rated validity using five domains: importance, appropriateness, clinical evidence, specifications, and feasibility and applicability.
“We believe that the next generation of performance measurement should not be limited by the use of easy-to-obtain (e.g., administrative) data or function as a stand-alone, retrospective exercise,” the researchers wrote. “Instead, it should be fully integrated into care delivery, where it would effectively and efficiently address the most pressing performance gaps and direct quality improvement. For now, we need a time-out during which to assess and revise our approach to physician performance measurement.”