As a means to improve outcomes and control costs, payers in the United States are increasingly using metrics to rate providers and health care organizations as well as to structure payment. However, payers should be careful not to mismeasure quality by prioritizing time- and cost-effectiveness over principles of patient-centeredness, evidence-based interventions, and transparency argue Barry Saver from the University of Massachusetts Medical School, United States, and colleagues in a Policy Forum article published in PLOS Medicine.
The authors highlight that the Centers for Medicare and Medicaid Services (CMS), which administers national health care programs in the US, is moving towards linking 30% of Medicare reimbursements to the "quality or value" of providers' services by the end of 2016 and 50% by the end of 2018 through alternative payment models. More recently, CMS announced a goal of tying 85% of traditional fee-for-service payments to quality or value by 2016 and 90% by 2018. However, at the same time the Medicare Payment Advisory Commission cautioned that "provider-level measurement activities are accelerating without regard to the costs or benefits of an ever-increasing number of measures"
The authors argue that evidence connecting many quality measures with improved health outcomes is modest, and metrics may be chosen because they are easy to measure rather than because they are evidence-based. They also warn that with payment at stake, clinicians and organizations may be tempted to game the system by devoting disproportionate effort to patients barely on the "wrong" side of a line rather than focusing on those at highest risk.
The authors argue for a fundamental change in the approach to quality measurement and propose a set of five principals that might help shape future quality measures and ensure that they reflect meaningful health outcomes.
The authors conclude, "[s]ubstantial resources are invested in public quality efforts that suggest progress, but implementing inappropriate measures is counterproductive, undermines the professionalism of dedicated clinicians, and erodes patient trust. [Our] principles are offered to help identify what is important for health, i.e., care that matters, so we may then develop quality measures more likely to reflect and enhance the quality of care provided, while minimizing opportunities for distortions such as gaming and avoiding the opportunity costs associated with efforts to optimize surrogate endpoints."