U.S. physician practices in four common specialties spend, on average, 785 hours per physician per year and $15.4 billion annually dealing with the reporting of quality measures, according to a new study.
While much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report, the researchers say. They note that the number of quality measures directed at U.S. healthcare providers by external entities such as Medicare, Medicaid, and private health insurance plans — such as rates of mammography screening for women or of testing for cholesterol or hemoglobin A1c levels for diabetes — has increased rapidly during the past decade. There are now at least 159 measures of outpatient physician care. (An abstract of the study is available online at http://bit.ly/1QFw2yk.)
The authors of the study say these measures impose a considerable burden on physician practices in terms of understanding the measures, providing performance data, and understanding performance reports from payers, but the extent of that burden has not been quantified. According to the study data, on average, physicians and staff spent a total of 15.1 hours per physician per week dealing with quality measures, with the average physician spending 2.6 hours per week and other staff spending 12.5 hours.
The most time — 12.5 hours of physician and staff time per physician per week — was spent on entering information into the medical record only for the purpose of reporting quality measures. The researchers determined that the time spent by physicians and staff translates to an average cost to a practice of $40,069 per physician per year.
“There is much to gain from quality measurement, but the current system is far from being efficient and contributes to negative physician attitudes toward quality measures,” the authors wrote. “Improving the system rapidly will be difficult. Obstacles include the fragmented U.S. health care system, lack of interoperability across EHRs [electronic health records], lack of EHR functionalities to facilitate retrieval of data for quality measures, the cost of change to external entities and to providers, and opposition from vested interests.”
The study notes several efforts to reduce the number of measures and to standardize their use across external entities, programs from the National Quality Forum, the Institute of Medicine, and America’s Health Insurance Plans, the Centers for Medicare & Medicaid Services, and the Agency for Healthcare Research and Quality.
“Our data suggest that U.S. healthcare leaders should make these efforts a priority,” the researchers wrote. “While much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report.”
Those conclusions were supported by Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association (MGMA).
“On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study of MGMA member practices is that nearly three-fourths of the groups reported being measured on quality measures that are not clinically relevant,” she said in a statement issued after the study was released. “The vast majority also stated current measures are useless for improving patient care. This study proves that the current top-down approach has failed. It serves no purpose to have over three thousand competing measures of quality across government and private initiatives.”
Although standardization is critical, it’s an exercise in futility if measures don’t improve patient care, she said.
“As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country,” she said.
