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Tuesday Mar 29, 2016

Finally, Alignment of Meaningful Quality Measures May be Reality

How many times in your career have you audibly uttered "why can't all insurance companies use the same quality measures and reporting process?" I'm guessing many of you have probably said it today.

A few weeks ago, I wrote about the AAFP’s 2016 advocacy agenda. In that post, I identified reducing "administrative complexity" and "alignment" as Academy priorities. The vast volume of rules, regulations, and guidelines that family physicians must navigate each day is a leading driver of professional dissatisfaction and frustration. A 2013 study(content.healthaffairs.org) of 23 health  insurers found that 546 quality measures were used, few of which matched across insurers.

Given that 61 percent of family physicians have contracts with seven or more payers -- each with their own quality reporting, prior authorization, and appropriate use criteria -- it's easy to understand why you are so frustrated with quality reporting and performance improvement programs.

One physician told me, "Unless you reduce the administrative and bureaucratic burden to primary care, family medicine will cease its existence. Time has a care value, care has a time value."  

This frustration is expressed by family physicians of all ages and in most practice settings.

Not to deemphasize the negative impact administrative complexity has on physicians' professional satisfaction, but the financial impact on physicians' practices is probably a bigger concern. As noted from the physician above, "time has a care value, care has a time value," and this is greatly out-of-balance. A recent study(content.healthaffairs.org) published in Health Affairs found that physicians individually spend $40,069 per year and, collectively, more than $15.4 billion annually to report quality measures.  Startling statistics, but the underlying commentary is what concerns me. It reads, in part, as follows:

"… physicians and their staff spend 15.1 hours per physician per week dealing with external quality measures including the following: tracking quality measure specifications, developing and implementing data collection processes, entering information into the medical record, and collecting and transmitting data. This is equivalent to 785.2 staff and physician hours per physician per year. The average physician spent 2.6 hours per week (enough time to care for approximately nine additional patients) dealing with quality measures."

The AAFP has long recognized and advocated for a reduction in the administrative burden placed on family physicians. In 2014, the AAFP ramped up its efforts when we engaged in a collaborative effort with CMS, America’s Health Insurance Plans (AHIP), and representatives from the patient community to identify and develop a set of core quality measures for primary care physicians. Our collaboration was supported by the National Quality Forum, and the National Committee for Quality Assurance to ensure that our work was adhering to the most recent science and evidence on quality and performance measurement. It's noteworthy that payers (CMS and commercial insurers) who participated in the collaboration represent approximately 70 percent of the combined population of Medicare Advantage enrollees and fee-for-service Medicare beneficiaries in the United States -- not to mention a clear majority of covered lives in the employer-sponsored and individual markets.

The collaborative developed a framework of three aims for our work which were:

  • Recognize high-value, high-impact, evidence-based measures that promote better patient health outcomes, and provide useful information for improvement, decision-making and payment.
  • Reduce the burden of measurement and volume of measures by eliminating low-value metrics, redundancies, and inconsistencies in measure specifications and quality measure reporting requirements across payers.
  • Refine, align and harmonize measures across payers to achieve congruence in the measures being used for payment and other accountability purposes.

These three aims were further articulated through 11 key attributes, one of which states "data collection and reporting burden must be minimized." A second key attribute stated, "measure sets for clinicians should be as parsimonious as possible and should focus on those measures delivering the most value."

I am pleased to report, that after nearly two years of work, our collaboration has produced a meaningful result for family physicians. On Feb. 16, the AAFP joined CMS and (AHIP) in announcing the establishment of a Core Measure Set for Primary Care and the Patient Centered Medical Home(www.cms.gov). This core measure set is an important step in reducing the administrative burden each of you experience on a daily basis. Furthermore, the adoption of this core set across all payers has real potential to reduce the negative financial impact on practices.

The AAFP is actively advancing the inclusion of this core measure set in the Medicare program and in the forthcoming Medicare Access and CHIP Reauthorization Act regulations. Additionally, we are pressing commercial insurance plans to include the core set in their next round of contracts for family physicians. We urge you to use AAFP resources  or the CMS webpage(www.cms.gov) to familiarize yourself with these core measures and insist that the insurance companies you contract with transition your practice towards these measures.

Posted at 07:00AM Mar 29, 2016 by Shawn Martin

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Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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