Half of Primary Care Physicians Think Quality Metrics Have a Negative Impact on Quality

In a Commonwealth Fund/Kaiser Family Foundation survey, 50 percent of PCPs report that quality metrics have a negative impact on their ability to provide quality care to their patients.ⁱ

If you spend any time in a primary care office practice this should come as no surprise. PCPs tend to be deeply dedicated to their patients and want very much to do the right thing.

Most of the initiatives aimed at improving health care focus on primary care. The burden of doing the work is complicated by the need to work on quality improvement (think extra meetings and tools). This is further complicated by the need to report not only on the work, but also on the efforts to improve the work and the effects of those efforts.

All of this extra work is happening while there is a primary care shortage and a national surge of demand for primary care services due to people with insurance under the ACA who are finally able to access primary care for conditions that may have gone untreated for years.

I blogged about the tsunami of quality metrics washing over health care, and want to reiterate some observations based on medical evidence and an opportunity to use information technology to help solve this problem.

Fewer measures

As humans, there is a natural limit to the number of things which we can attend to at any given time: more is not better. The medical literature tells us that we tend to focus on a few quality measures while the rest drift.ⁱⁱ

Focus on outcomes

Testing a person’s blood sugar is not the same as effective treatment. We’re really interested in the outcome, so let’s focus on outcomes. If we really want improved population outcomes we ought to focus on population outcomes in reference to disease outcomes. Have we reduced unnecessary hospitalizations? Helped people gain greater function in their daily lives? Reduced complications, improved the lives of the people we serve?

Good technology to reduce the burden

EMR data is highly variable, interoperability is problematic and health plan claims are old. In spite of this, advances in natural language processing, data capture, normalization and analytics are bringing solutions to the problem.

Clinically integrated networks, ACOs and others can focus on the improving the fundamentals that drive outcomes while absolving PCPs of the burden of reporting. System leadership should leverage technology to feed the external reporting beast while providing enabling technology to PCPs who want to focus on what’s best for their patients and not be distracted by well-intended but burdensome policies.

L. Gordon Moore, MD, is senior medical director for populations and payment solutions at 3M Health Information Systems.

How much are ACOs really improving outcomes and reducing costs? Click to take a look at the numbers.  

ⁱThe Commonwealth Fund and The Kaiser Family Foundation, Primary Care Providers' Views of Recent Trends in Health Care Delivery and Payment, August 2015.

ⁱⁱGillam, S. J., A. N. Siriwardena, and N. Steel. “Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework–A Systematic Review.” The Annals of Family Medicine 10, no. 5 (September 10, 2012): 461–68. doi:10.1370/afm.1377.