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ACP calls for revision of physician performance measurements

Jack Ende

In Medicare’s Merit-based Incentive Payment System, or MIPS, most ambulatory internal medicine quality measures are not compliant with ACP criteria, according to ACP in a paper published in the New England Journal of Medicine.

“ACP has long supported and advocated improving performance measures so they help physicians provide the best possible care to their patients without creating unintended adverse consequences,” Jack Ende, MD, president of ACP, said in a press release.

To address physicians’ concerns that current performance measures do not meaningfully improve patient outcomes, ACP conducted an analysis of 86 measures in Medicare’s MIPS and Quality Payment Program. The analysis revealed that 37% of the performance measures were valid, 35% were not valid and 28% were of uncertain validity. A majority of measures that were not valid had insufficient supportive evidence.

Some performance measures included poor specifications that could potentially lead to the misclassification of high-quality care as low-quality care, according to the ACP. Measures containing flaws frustrate physicians and may be harmful to patients, ACP noted.

Performance reports cost physician practices $15.4 billion per year, yet almost two-thirds of physicians report that the quality of care that they provide is not adequately captured by current performance measures, according to ACP.

Leading organizations in the United States showed “troubling inconsistencies” in how they rate the validity of physician quality measures, according to ACP.

The ACP recommended that a set of standards for the evaluation of the trustworthiness of performance measures be developed. Performance measurement should not be an isolated drill and not be limited by administrative data, according to ACP.

“A possible solution is to have physicians with expertise in clinical medicine and research develop measures using clinically relevant methodology,” Ende said. “Performance measures should be fully integrated into care delivery so they can help to address the most pressing performance gaps and direct quality improvement.”

Noting that more than 2,500 measures are used inconsistently, ACP urged for a “time out” to review and improve how physician performance is being assessed. – by Alaina Tedesco

Disclosure: MacLean reports no relevant financial disclosures. Please see paper for all other authors’ relevant financial disclosures.