From the Journals

Doctors call for a pause to rethink MIPS measures



A “time-out” is needed to reevaluate how quality measures are used as part of Medicare’s Merit-based Incentive Payment System (MIPS), according to officials at the American College of Physicians.

The call comes in the wake of an analysis of MIPS quality measures that found a majority are not valid for ambulatory care internal medicine, according to ACP criteria.

Dr. Jack Ende, president of the American College of Physicians

Dr. Jack Ende

Of the 86 MIPS quality measures considered relevant to ambulatory general interest medicine, 37% (32) were rated as valid, 35% (30) were rated as invalid, and 28% (24) were rated as of uncertain validity, Catherine H. MacLean, MD, and her colleagues on the ACP Performance Measurement Committee wrote in a perspective published April 18 in the New England Journal of Medicine.

The quality measures were assessed regarding importance, appropriate care, clinical evidence base, measure specifications, and measure feasibility and applicability.

“We also determined that the proportion of the measures that had been developed by the National Committee for Quality Assurance [NCQA] or endorsed by the National Quality Forum [NQF] that were rated as valid by our method,” Dr. MacLean and colleagues wrote. “As compared with measures that were not endorsed by these organizations, greater percentages of NCQA-developed and NQF-endorsed measures were deemed valid [59% and 48%, respectively, vs. 27% for nonendorsed measures], and smaller percentages were deemed not valid [7% and 22% vs. 49% for nonendorsed measures].”

The lack of measures that were found to be valid for primary care is frustrating for doctors and could cause harm to patients, according to the authors.

“We need a time-out during which to assess and revise our approach to physician performance measurement,” they wrote.

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