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The Evolution of Quality Measurement and Efforts to Streamline Reporting

Laura Joszt
Quality measurement has been around for nearly 2 decades and in that time measures have evolved and also proliferated to the point of placing considerable burden on physicians and health systems. New efforts are being made to streamline current measures, fill in gaps, and harmonize measures across programs.
Quality measurement is a complicated field that is becoming increasingly important as the healthcare industry moves toward value-based care. However, years of proliferation and a lack of centralized guidance has led to an overabundance of measurements and a considerable burden on physicians, practices, and health systems.

Quality measures, which have been around for nearly 2 decades, serve 2 main purposes:
  • Internal measurement so organizations can improve on the care they provide
  • External reporting to payers or the public
The second purpose becomes increasingly important as quality measures are incorporated into payment programs with the implementation of alternative payment models (APMs), noted John Bernot, MD, vice president of quality measurement initiatives at the National Quality Forum (NQF).

While quality measurement reporting is a key part of APMs, “with the number of measures that are required to be reported and the burden on practices to report them, I feel there are some shortcomings and areas of opportunity for improvement,” said Scott Hines, MD, chief quality officer of Crystal Run Healthcare, and a member of the board of directors for the American Medical Group Association (AMGA).

As a practicing family physician, Bernot has first-hand experience with the impact of measurement proliferation. He explained that there are times when he and his colleagues have 2 ways to report a diabetes measure for 1 patient because there are different programs.

The burden has also been documented in literature. In March 2016, Health Affairs published1 the results of a study of the reporting burden in 4 specialties: cardiology, orthopedics, primary care (family medicine and general internal medicine), and multispecialty practices that included primary care. The research found that the physicians studied spent, on average, 785 hours per year and a total of $15.4 billion a year on quality reporting .

AMGA's member survey found that, on average, about 17 information technology people need to be hired for every 100 physicians, Hines explained. Part of the reason that technical support is needed is to deal with the burden of quality reporting and pulling the data from electronic health records for reporting to payers.

Jerry Penso, MD, MBA, president and CEO of AMGA, added that members have told the organization that quality measurement reporting is time consuming and detracts from overall patient care. They asked AMGA to help streamline the measures and narrow the measures down to the ones that are the most important and relevant.

Recently, AMGA released a streamlined set of 14 quality measures for value-based contracts. As part of its effort, AMGA looked not only at the most relevant measures, but also those that can be risk adjusted when needed, are evidence-based, are claims-based, have demonstrable results, and improve the patient experience.



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