Hospitals and health systems could more effectively address quality improvement by narrowing the metrics used to those that are meaningful and easy to understand, experts say. A more prudent selection of quality measures could improve physician compliance and success with improvement goals, while the use of data analytics can give an additional boost.
With an estimated 36,000 quality measures foisted on healthcare providers throughout the industry, it can be hard for physicians and other clinicians to focus on what matters most, says Jay LaBine, MD, chief medical officer with naviHealth, a post-acute care management company in Nashville, TN. LaBine recently worked for Spectrum Health as senior vice president and chief medical officer for Priority Health.
No one hospital or health system will use all of those measures, of course, but the volume of metrics and the inconsistency across healthcare institutions can thwart quality improvement efforts, he says. Physicians are increasingly concerned about the excessive complexity and administrative burden of quality measures, LaBine says.
“Physicians can’t understand all these measures. They’re extremely complicated, and there’s a disconnect between physician understanding and what quality really is,” LaBine says.
“The measures are very detailed and prescriptive, which breeds concerns over whether they are really quality concerns or something else.”
The Bundled Payments for Care Improvement Advanced (BPCI Advanced) program from the Centers for Medicare & Medicaid Services (CMS) has many physicians concerned about the required metrics and how they will be affected, LaBine says. (More information on BPCI Advanced is available on the CMS website at: https://bit.ly/2mcB3me.)
“We definitely want quality measures for something like the bundled payment program, but the real question is how prepared CMS is to administer the quality measures. They’re hearing from a lot of providers with concerns about how difficult this is going to be for them to get specificity and understand how they are doing so they can improve if they are not measuring up,” LaBine says. “Is this going to be an administrative checkbox or a real, meaningful practice pattern change?”
LaBine cites the advance care planning measure, which encourages conversations with patients about advance care directives for patients in the bundled care program. But how that is measured is not well understood. And will it be a meaningful conversation, or just a perfunctory task so the checkbox can be marked?
The goal should be to measure the quality of care provided to the patient, LaBine says. That might seem obvious, but to physicians some of the quality measures can be perceived as far afield from what actually matters to patient outcomes, he says.
Tying patient outcomes to compensation often is intended to convince physicians that the organization is focused on patient care rather than a bureaucratic or arbitrary measure, he says.
“But how do you tie those quality measures to compensation when they are so complicated that the physician has to pay a quality subject matter expert to explain to the physician exactly what they are doing and how to measure it?” LaBine says.
“It would be easier if you said ‘we’re going to measure these three or four quality measures that are straightforward, meaningful, and easy to understand.’ Physicians are trying to make sense of these measures tied to their compensation, but they’re struggling to understand them while still dealing with the challenges of medicine.”
Many physicians are encouraging the use of patient-reported outcomes as the predominant measure of quality, LaBine says.
- Jay LaBine, MD, Chief Medical Officer, naviHealth, Nashville, TN. Phone: (615) 577-1900.