Approximately 2500 performance measures for US physicians are listed by the National Quality Measures Clearinghouse. The use of these measures for assessing performance has steadily increased in recent decades across most healthcare systems. Performance scores are also used to identify care value as it relates to fee-for-service payments to clinicians. Despite their proposed benefit, some policymakers and physicians find no real meaningful value in current performance measures, according to a perspective piece published in the New England Journal of Medicine.
The quality of performance measures has become an increasing topic of discussion in recent years. Most recently, the Performance Measurement Committee of the American College of Physicians (ACP) developed a set of criteria to assess the validity of various performance measures, with review criteria including importance (eg, meaningful clinical impact), appropriate care, clinical evidence base, measure specifications (eg, clarity of measure), and measure feasibility and applicability.
Study investigators sought to determine the validity of the ACP criteria when applied to the measures in the Medicare Merit-based Incentive Payment System (MIPS)/Quality Payment Program (QPP). A total of 86 measures in the QPP were included for validity analysis. Using this method, investigators found that approximately 37% of measures were valid, 35% were deemed not valid, and another 28% had uncertain validity. A total of 19 measures that were rated as not valid were found to have little evidence to support their use.
According to the investigators, important clinical implications at the physician level of performance measurement should be considered when interpreting the study’s findings. Considering that “only 37% of measures proposed for a national value-based purchasing program were found to be valid with a standardized method,” it is possible that these measures could ultimately lead to issues with patient care. In addition, the use of all current performance measures “may introduce inefficiencies and administrative costs into a health system widely regarded as too expensive.”
The investigators also added that the next generation of performance measurement “should be fully integrated into care delivery, where it would effectively and efficiently address the most pressing performance gaps and direct quality improvement.”
MacLean CH, Kerr EA, Qaseem A. Time out—charting a path for improving performance measurement [published online April 18, 2018]. N Engl J Med. doi:10.1056/NEJMp1802595.