More than half of primary care physicians surveyed say the growing use of quality metrics to assess provider performance is having a negative impact on quality of care.
Metrics that don't give the whole story, confusing health information technologies and new care delivery systems are among the challenges clinicians contend with—and they're growing increasingly disgruntled and concerned about effects on patient care, a recently released survey shows.
A survey by the Commonwealth Fund and Kaiser Family Foundation asked the nation's docs to share their woes and found that more than half are dissatisfied with changes in primary care payment and care delivery. The most severe of grievances are around quality metrics tied to reimbursements, which many clinicians claim are unfair.
Amy Mullins, MD |
Of the 1600 primary care physicians surveyed, 55% said the growing use of quality metrics to assess provider performance is having a negative impact on the quality of care. Less than a quarter said that quality metrics have a positive impact on healthcare quality.
Fifty-five percent of the nation's primary care physicians are currently receiving financial incentives based on quality or efficiency measures. Fifty-two percent cited concerns around programs that impose financial penalties for unnecessary hospital readmissions.
The survey also interviewed 525 midlevel primary care providers, including nurse practitioners and physician assistants.
Not the Whole Story
The survey results come as no surprise to Amy Mullins, MD, medical director of quality improvement at the American Academy of Family Physicians in Leawood, KS, who says the lowered approval is consistent with her experiences working to help "harmonize" payer quality metrics with the concerns of family physicians.
"It often seems [payers] are measuring to measure, not measuring to improve quality," she says, and that clinicians receive little feedback as to how they can improve their quality of care. She also says there is a perception that there is more push to measure the quality than to actually improve it.
NQF Wants Risk-Adjusted Outcomes, Costs, Payments
Clinicians say they cannot give payers a backstory when submitting numbers to determine reimbursement, she says. "There are so many social determinants of health that get left out of the equation," adding that there is no adjustment available for clinicians who serve underprivileged or at-risk patient populations.
"A number doesn't tell the story of a patient population that has challenges with transportation, that can't afford medication on routine basis, or maybe can afford one medication this month, but not both of the medications you've prescribed them. Or the patient population that lives far away from greenspace or in an unsafe neighborhood… and cannot afford to get healthy."
Like Mullins, Eric Schneider, MD, senior vice president for policy and research at The Commonwealth Fund, was unsurprised by these findings. "These numbers are pretty consistent with what we've seen. The negative views of quality metrics and financial penalties are not uncommon," he says. "Many clinicians would say that quality metrics don't always reflect how they add value."
Challenging Changes
The survey also highlighted concerns clinicians have around other changes in healthcare, including accountable care organizations, electronic health records, and clinicians choosing to exit the profession rather than adjust to new standards.
Eric Schneider, MD |
Physicians Vent EHR Frustrations
Twenty-six percent of primary care physicians view the spread of ACOs as having a negative impact on quality, while 14% say ACOs have improved quality of care. Even among clinicians who work in an ACO, opinions are contentious, with 30% holding positive views, and 24% negative.
Electronic health records systems are a source of consternation for many healthcare workers, but 50% of physicians and 64% of nurse practitioners surveyed say EHRs and other health information technology have improved quality of care.
Physician Compensation, Dissatisfaction Ratchet Up
Nearly half of physicians and more than a quarter of nurse practitioners and physician assistants who responded to the survey said the recent trends in healthcare are leading them to consider an earlier retirement. This continues a 20-year trend of physician dissatisfaction with market trends in health care.
"The trend of considering early retirement has been observed," says Schenider. "It's never clear if they actually do end up retiring early, but some do talk about it."
But healthcare leadership should actively work to find common ground with clinicians when it comes to quality metrics, says Mullins. "Moving forward, quality improvement is going to be tied to metrics. These two things are going to be married. We have to find ways to do this work and do it well."