"In the absence of performance measurement approaches that amass larger numbers of eligible patients at the physician or practice level, the results from this study call into question the wisdom of pay-for-performance programs and quality reporting initiatives that focus on differentiating the value of care delivered to the Medicare population by primary care physicians. Novel measurement approaches appear to be needed for the twin purposes of performance assessment and accountability," the authors conclude.
Editorial: Measuring Physicians' Quality and Performance
In an accompanying editorial, Donald M. Berwick, M.D., M.P.P., of the Institute for Healthcare Improvement, Cambridge, Mass., offers suggestions on how to improve measurement of quality and performance.
"First, the effective sample sizes contract rapidly when the focus is on specific diseases or patient subpopulations. By relying on highly focused quality metrics one at a time, Nyweide et al are viewing care through a tiny keyhole. If valid quality metrics could be constructed that cross conditions, more patients could contribute relevant data. Second, more could be known if data could be aggregated from all payers, not just Medicare. Creating shared pools of transparent performance information for Medicare, Medicaid, and private insurers would be a step toward maturation in the ability to improve U.S. health care."
"Third, patients can and should be asked directly about their experiences of care. The uniform use of the Hospital Consumer Assessment of Healthcare Providers and Systems survey measures in Medicare goes in the right direction, but much more should be invested in listening to patients and their families, helping them to describe how well they feel treated. And fourth, the ability to measure and track individual patients' health and function over time and place should be expanded. Measuring a mammography rate or the frequency of assessment of glycated hemoglobin is a far cry from measuring true aims: health, function, and comfort."
Source: JAMA