Committee assesses whether performance measures lead to improved clinical outcomes, shares findings with regulatory bodies
Sept. 23, 2022 (ACP) — Doctors are drowning in performance measures -- many of which have little, if any, bearing on patient care, yet can be extremely burdensome for practices to report.
The Medicare Access and CHIP Reauthorization Act was designed to shift physician payment so that it rewards value and quality over volume via the creation of the Quality Payment Program (QPP). The QPP offers two pathways for reimbursement: the Merit-Based Incentive Payment System (MIPS) and advanced alternative payment models. Through MIPS, physicians must report certain performance measures across four categories -- quality, promoting interoperability, improvement activities and cost — to determine their future Medicare reimbursement rates.
Enter the American College of Physicians' Performance Measurement Committee.
“We are looking to impact doctors' practices so that they can focus more on taking care of patients and not worry about checking a box to meet low-value performance measures,” said Dr. Nick Fitterman, chair of the ACP Performance Measurement Committee, executive director of Huntington Hospital and assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York.
“We take a scientific approach to assess performance measures that relate to internal medicine physicians to understand if they are valid and improve patient care or if physicians are merely spending resources, time and effort on measures that add nothing to health care,” Fitterman explained. The committee then approaches regulatory bodies and shares their findings and insights.
And so far, their work has contributed to the removal of 12 low-value performance measures from MIPS. An additional measure is currently up for consideration of removal.
“They don't always listen,” Fitterman said, “but our work has resulted in some positive changes.”
For example, the Centers for Medicare & Medicaid Services removed a performance measure encouraging clinicians to retrieve all specialist reports for adults with major depressive disorders and comorbidities because it is burdensome, especially if the primary care clinician did not refer the patient to the specialist. In addition, there is a lack of high-quality evidence on the impact of such disease communication on meaningful clinical outcomes.
The goal is not to get rid of performance measures altogether, Fitterman stressed, adding “we do need performance measures that can advance care.”
The committee has also encouraged meaningful changes to the Closing the Referral Loop measure by decreasing the reporting time frame. This measure calls for the doctor who referred the patient to receive a report from the doctor to whom the patient was referred, thus closing the referral loop. The modification allows adequate time for the referring clinician to collect the consult report by the end of the measurement period.
About the Performance Measurement Committee
The Performance Measurement Committee evaluates performance measures using a modified RAND-UCLA appropriateness method to determine whether they are evidence-based, methodologically sound and clinically meaningful.
The committee includes ACP members from a variety of health care settings. They meet every four months in person, but are in constant communication with one another in between meetings, Fitterman said.
Some questions asked during the evaluation process include:
- Will this measure lead to improved clinical outcomes?
- Does this measure address a high-impact condition?
- Is there an opportunity for performance improvement?
- Is this measure evidence-based or under the physician's control?
“We align our recommendations with the evidence that comes out of ACP's clinical guideline committees,” Fitterman said.
Information on the Performance Measurement Committee, the measures it has evaluated and papers that have been published, is available on the ACP website.