How do physicians view meaningful quality metrics, as defined by CMS? Not favorably, according to one survey.
As the push to pay for healthcare quality, not quantity accelerates, CMS has released core quality measurement sets aimed in part at reducing the variability and burden of data collection on doctors and facilities. The result of a collaborative effort between the government, commercial payers, physician associations and patients, these core measurements were designed to be meaningful to patients, consumers and physicians.
A recent Cejka Search Healthcare Perspectives survey of 1,621 practicing physicians and administrators provides insight on what physicians want to see in order to fully support these quality metrics. The survey found that while there was wide support among physicians for a quality versus quantity payer system, they ranked priorities such as patient communication, clinical team collaboration and being viewed as a partner in a patient’s long-term wellness, higher than achieving quality metrics set by their facility.
The reason, many cited, was the need for more meaningful definition and measurements of quality. For example, one physician stated, “Most are still quantity-based metrics disguised as value,” creating the sense that doctors were being asked to spend a significant amount of time collecting data they view as less meaningful.
Importance of Measuring Outcomes
According to Morris Seligman, physician and executive vice president and chief medical officer of Mountain States Health Alliance, one of the problems is that the CMS has historically measured the “process of care” in terms of the volume of patients who received a certain test or procedure. “While monitoring the process on aggregate is important, in the context of the physician-patient relationship what matters most is the outcome,” he says.
Dr. Seligman gave the example of measuring outcomes for diabetics, such as, “how many avoid life-limiting and costly complications, including amputation, dialysis and blindness; instead of limiting quality metrics to the number of foot exams, eye exams, or renal insufficiency tests prescribed.”
Evaluating Claim Data within the Context of Total Care
Thomas Diller, physician and vice president and system chief medical officer at Christus Health, gave an example from his days as a vice president of quality and safety at a physician-led health system. The group did such a good job of managing its Congestive Heart Failure (CHF) patients that it only admitted its sickest, often terminal patients to the hospital. As a result, in 2011 the group was penalized by the CMS for mortality rates despite being ranked the second best in the nation for CHF readmission rates and delivering exceptional care. “This is an example of how claim-based metrics can actually detract from quality care,” said Dr. Diller.
How to Gain Physician Buy-In on Goals and Measurements
Survey respondents explained that the best way to gain physician support is to engage them as partners in solving healthcare delivery problems, giving them a voice in the discussion and an opportunity to understand the science behind an initiative.
Specific to the adoption of meaningful quality metrics, physicians described the importance of:
1. Involving physicians in the process of defining and selecting quality metrics.
2. Selecting metrics on the basis of medical evidence that proves a positive correlation with quality outcomes.
3. Holding physicians accountable for quality measures that are reasonably within their control.
4. Streamlining the collection of data so as not to detract from the quality of the patient experience.
Based on the above physician criteria, the Core Quality Measure Collaborative, comprised of multiple stakeholders including physicians and patients, is a step in the right direction, and the objective of promoting alignment of meaningful data usage and collection across government and commercial payer systems is a useful goal.
John Gramer is president of Cejka Search, a nationally recognized physician search and healthcare executive search firm specializing in healthcare for more than 30 years.