Although U.S. physicians are evaluated on over 2,500 performance measures, less than 40 percent of these metrics are considered valid, according to a study published in The New England Journal of Medicine.
To determine the validity of these performance measures, a committee for the American College of Physicians created a five-item checklist to measure importance, appropriateness, strength of clinical evidence, feasibility of implementation and applicability.
The ACP committee analyzed 86 performance measures pertinent to general internal medicine practice. The measures were part of the Medicare's Merit-based Incentive Payment System/Quality Payment Program, which aims to connect physician performance and patient outcomes to reimbursement.
CMS aims to link 90 percent of physician payments under Medicare's fee-for-service system to performance metrics before 2019. However, the agency requested proposals for revised measures. "We hypothesized that if most of the measures assessed were deemed valid using this process, physicians could have more confidence that adherence to the measures would result in improved patient outcomes," the study authors wrote.
Only 37 percent of quality measures the ACP committee assessed met their validity criteria. Of the remaining measures, 35 percent were deemed invalid while 28 percent had uncertain validity.
"Quality measures only should be based on practices about which we are certain there is a meaningful health benefit. There should be no controversy in quality measures," said lead researcher Catherine MacLean, MD, PhD, in a press release. The study authors emphasized they are not dismissing the need for performance measures for physicians, but call for changes to the way the assessments are created.
One step toward changing how these assessments are developed is to avoid placing too much reliance on administrative data, such as billing claims, since they lack detailed information and nuance, the study authors noted. Additionally, the assessments should move toward a system where physicians receive feedback on their performance in real time as opposed to being evaluated long after they deliver care.
"The point of the paper isn't that we don't support quality measures. We've had careers in developing them," Dr. MacLean said. "The problem is that bad quality measures can be harmful. Additionally, they are a waste of time; they're frustrating, and they're a waste of money. It's gotten to the point where it's almost measures for measurement's sake."