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Doctors doubt quality metrics improve quality of care


 

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Quality measures may be essential to creating health care systems focused on value over volume, but physicians aren’t convinced that current quality metrics are improving outcomes.

In addition, “physicians’ views tilt negative on the effect ACOs [accountable care organizations] have had on the quality of care, and many are still not sure of their effect,” according to a report by the Commonwealth Fund and the Kaiser Family Foundation.

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The organizations surveyed 1,624 physicians and 535 other primary care providers, including nurse practitioners and physician assistants.

A total of 55% of physicians reported receiving payments or incentives based on quality or utilization. Nearly two-thirds of physicians said they received salaries or capitation, while 34% of physicians were fee-for-service only. And 29% of physicians were part of an ACO, while 9% were preparing to join one.

Overall, clinicians “were more negative about the use of quality metrics to assess their performance, even those providers who receive incentive payments based on quality,” according to the report. In addition, recent health care trends are causing nearly half of physicians (47%) to consider early retirement.

Half of all surveyed physicians responded negatively when asked if they thought “the increased use of quality metrics to assess provider performance is having a positive, negative, or no impact on primary care providers’ ability to provide quality care to their patients.”

Dr. William Golden

Dr. William Golden

That 50% negative rate was consistent among physicians who have received incentive payments based on quality of care and those who have not. Overall, only 22% of physicians said it was having a positive effect. That number increased to 28% among those who have received incentive payments and dropped to 17% among those who have not.

A total of 38% of physicians were unsure if they thought the increased use of accountable care organizations “is having a positive, negative, or no impact on primary care providers’ ability to provide quality care to their patients,” while 26% said ACOs are having a negative impact, and only 14% said the effect was positive.

For those clinicians in ACOs, 25% were unsure of ACOs’ impact, while 24% said it was negative, and 30% said it was positive. Among physicians not in ACOs, 43% were unsure of ACOs’ impact, 27% said ACOs were having a negative impact, and 7% said the impact was positive. About 20% of survey respondents said there was no impact, a number that was consistent among physicians in and not in ACOs.

“I am not surprised by these data,” said Dr. William Golden, professor of medicine and public health at the University of Arkansas for Medical Sciences, Little Rock.

“The implementation of quality measurements and performance incentives has often been awkward and ineffective,” added Dr. Golden, who also serves as medical director for Arkansas Medicaid. “Too many incentives use burdensome, unreliable metrics with clumsy rewards. The current situation reflects poor program design and not the failure of quality measurement as a concept.”

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