The new measurement set is designed to generate valuable clinical care and outcome data without placing a crushing administrative burden on physicians and their organizations.
The American Medical Group Association has endorsed 14 metrics as a value and quality measurement set for data reporting in payer contracts.
Widespread adoption of the new measurement set would address the administrative burden and burnout associated with the current patchwork of reporting regimes, says Jerry Penso, MD, MBA, president and CEO of the AMGA.
"Our members told us that the burden of reporting the current quality measures was great; mainly, time to run the measures and time out of clinical practice for physicians to input the data," he says.
The AMGA, which is based in Arlington, Virginia, represents physician groups and health systems nationwide. More than 175,000 physicians practice at AMGA member organizations.
"Reporting is also a factor in physician burnout," Penso says. "That's a flaw in the current measurement system. There are too many measures, and they are not harmonized between the different insurance programs."
In 2016, Health Affairs published research that shows the costly consequences of the current reporting system. The study found that physician organizations spent $15.4 billion annually to report quality data and the average physician worked for 785 hours yearly on reporting.
The AMGA's 14 measures feature both process measures such as cancer screening and outcome measures such as hospital readmission rates:
- Emergency department use per 1,000
- Skilled nursing facility admissions per 1,000
- 30-day all cause hospital readmission
- Admissions for acute ambulatory sensitive conditions composite
- HbA1C poor control
- Depression screening
- Diabetes eye exam
- High blood pressure control
- CAHPS, health status, and functional status
- Breast cancer screening
- Colorectal cancer screening
- Cervical cancer screening
- Pneumonia vaccination rate
- Pediatric well-child visits through age 15 months
A task force drawn from the AMGA's 22-member Public Policy Committee used multiple criteria to select metrics for the new measurement set, Penso says. "They were aiming for a smaller set—14 to 25 measures—as their final target."
He says there were seven primary selection criteria:
- Measures had to be clinically relevant and impactful on patient lives
- Risk-adjustable measures were preferred
- Measures had to be evidence based, with scientific evidence of care improvement
- Claims-based measures were preferred because of the ability to report from claims data
- Track records were required—measures needed to demonstrate an ability to improve quality through past performance
- Measures that accounted for patient experience were preferred because a patient's perception of care is an important outcome
- Metrics needed to have a large enough sample size to be statistically valid for performance comparisons
The current reporting system is overkill, Penso says.
"The way many people use quality measures is for external reporting—it could be part of a value-based contract or public reporting for patients. Our point is that all of the measures that are out there do not need to be used for this purpose."
The AMGA is not seeking to replace or abolish metrics that were not included in the new measurement set, he says.
"A lot of other quality measures can be used for internal improvement. Physician groups can use our measures, then use other quality measures for internal benchmarking and internal management of performance improvement initiatives."
Taken as a whole, the new measurement set gauges not only quality but also value, Penso says.
"Quality is important to all of us, our patients, our families, and our providers. But our value measure set has other metrics that are important like utilization, cost, and patient safety."
Christopher Cheney is the senior clinical care editor at HealthLeaders.