ACP Performance Measurement Committee Makes Recommendations on Performance Measures for Osteoporosis

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Using newly developed algorithm, the committee identified a gap in measuring early treatment, suggests changes to improve osteoporosis diagnosis and treatment

Oct. 20, 2023 (ACP) -- A recent review of current performance measures to evaluate the quality of osteoporosis care revealed that only one of six performance measures for osteoporosis included in the Merit-Based Incentive Payment System program is supported at all levels of attribution.

In a paper detailing the review and recently published in the Annals of Internal Medicine, the authors from the American College of Physicians Performance Measurement Committee (PMC) suggest that new performance measures be developed to improve osteoporosis diagnosis, treatment and care.

Performance measures have been developed and used for a variety of health issues, including osteoporosis, to optimize patient care delivery at the individual physician and group practice levels. While these performance measures are often useful to public reporting or payment programs, when the measures are significantly flawed, they create unnecessary administrative burdens for physicians.

“Measures are complex and are rarely perfect, but when these measures are frequently used in different programs with significant public reporting, accountability or payment effects, they need to be critically assessed. In many cases, whether osteoporosis or other measures, it may be quite reasonable for a population health measure to be used at the level of a large group or health care system, but it may not be appropriate or reasonable for that measurement to be applied to an individual physician,” explained Dr. Robert McLean, ACP president emeritus, current member of the PMC, a practicing rheumatologist at Northeast Medical Group of Yale New Haven Health in Connecticut and a clinical professor of medicine at the Yale School of Medicine.

The ACP PMC has called for performance measures to demonstrate a methodologically sound basis with appropriate statistical analysis. To aid the development of clinically sound performance measures, the PMC developed an algorithm to categorize ACP guideline recommendations and determine if there is enough to support a performance measure concept. The algorithm considers strength and certainty of evidence, performance gaps, feasibility and applicability.

The committee's review of osteoporosis performance measures showed only one of six osteoporosis performance measures is valid at all levels of attribution, including the individual physician, group practice and health plan levels.

The review also revealed there is no performance measure that addresses the initial approach to therapy for patients with a new diagnosis of osteoporosis. “The closest performance measure evaluates whether a patient with a fracture received a dual-energy X-ray absorptiometry scan or a prescription for any pharmacotherapy to treat osteoporosis, even though there is clear guidance around using bisphosphonates for initial pharmacologic management,” McLean and colleagues write in the paper. Therefore, the PMC used its algorithm to derive a performance measure concept from ACP clinical guidance to fill this gap.

According to McLean, the PMC is working to critically evaluate proposed or existing measures to close any recognized gaps in quality or performance. “The nuances of many of these performance measures require some careful analysis and cannot be minimized,” he said.

Some proposed measures work better alongside existing measures rather than on their own. In a Sept. 11 letter to the Centers for Medicare and Medicaid Services commenting on the proposed Medicare Physician Fee Schedule, ACP expressed concerns about using composite performance measures to replace individual preventive measures. “While composite measures gained favor because they offer the promise of providing a clearer picture of overall performance, they should not be used alone. Rather, they should be a complement to individual measures when profiling and creating incentives for improvement,” ACP writes in the letter.

McLean hopes that “pointing out where performance measures fall short … will ultimately help in the development of good performance measures that do in fact improve the quality of care for our patients and are appropriately able to be measured and captured by our physicians as well as health systems in ways that are valid and reliable.”

More Information

The review paper, “Quality Indicators for Osteoporosis in Adults: A Review of Performance Measures by the American College of Physicians,” is available on the Annals of Internal Medicine website.

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