Performance Measures Matter

AAFP Urges Improvements to Draft Recommendations

May 24, 2016 09:10 am News Staff

The AAFP is hugely invested in the topic of performance measurement because measuring different aspects of patient care is an integral part of new payment models that will come with implementation of the Medicare Access and CHIP Reauthorization Act (MACRA).

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Therefore, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., was quick to respond with recommendations related to a recently released draft white paper( titled "Accelerating and Aligning Population-Based Payment Models: Performance Measurement."

The draft was written by the population-based payment workgroup that is part of the Health Care Payment Learning & Action Network.(

In his May 9 letter(4 page PDF) to workgroup leader Sanne Magnan, M.D., Ph.D., Wergin applauded the group's work to harmonize performance measures across all payers.

"The AAFP supports reasonable and achievable quality, cost and other outcome measures that promote continuous quality improvement and measure patient experiences," said Wergin.

However, "The AAFP opposes any approach that requires physicians to report on a complex set of measures that do not impact or influence the quality of care provided to patients."

Story Highlights
  • AAFP Board Chair Robert Wergin, M.D., recently responded to a draft paper on population-based payment models and performance measurement that was released by a workgroup from the Health Care Payment Learning & Action Network.
  • Authors identified four priority issues moving forward: patient attribution, financial benchmarking, data sharing and performance measurement.
  • The authors made a number of recommendations that included creating measures that matter to patients; recognizing a national data infrastructure; and developing measurement systems that reward improvement, promote sharing best practices and avoid a forced curve that mandates winners and losers.

He agreed with the workgroup's four priority issues -- patient attribution, financial benchmarking, data sharing and performance measurement -- that were identified as "foundational to the success" of population-based payment models.

Detailing Recommendations

The draft paper made a number of recommendations and led with a suggestion that future measures "be based on results that matter to patients."

Wergin noted the AAFP's agreement with the recommendation and recognized the "challenges associated with its execution."

Those challenges, as outlined by the workgroup, include a clumsy measure development process and a lack of patient-reported data captured by electronic health record (EHR) systems.

Wergin reiterated the Academy's view that outcome measures are "an end point and not a starting point."

"Establishing strong and meaningful process measures tied to evidence-based outcomes can help lead a practice toward improvement," said Wergin. He noted that the Core Quality Measures Collaborative -- a group in which the AAFP has shown great leadership -- recently released core measures that will help physicians make incremental practice changes

Eventually, the AAFP expects those changes to "roll up to more outcome-oriented measures," said Wergin. "Improvements at a physician practice or site are the only way to show meaningful impact on population-based performance," he added.

The draft document's authors also recommended that core measure sets be comprehensive and outcome-oriented.

Wergin responded that for performance measures to be effective, they must be clinically relevant, harmonized among all payers, fairly easy to report and cost-effective to gather.

Furthermore, a primary care provider's ability to improve performance relies heavily on the availability of "timely, accurate, and actionable quality and cost data" for all of the physicians and other health care professionals who contribute to the care of that physician's attributed population, said Wergin.

The workgroup also called for a "governance process" to oversee the measure development process.

In response, Wergin called the current process "long, cumbersome and expensive." He agreed that the HHS secretary should "lead the effort to establish measure priorities," with input from outside groups.

Furthermore, said Wergin, "All major public and private payers need to be involved during measure development to ensure commitment and alignment throughout the process" and to prevent "duplication of effort" and "opposing end points."

The workgroup recommended the provision of "meaningful incentives" to encourage physicians to deliver high-quality care, achieve favorable outcomes and manage the total cost of care.

Wergin responded that meaningful incentives needed to include "an increased investment in primary care."

That investment, he said, must embrace

  • better payment for primary care-specific evaluation and management visits,
  • fair monthly care management fees from all payers to cover practice transformation and sustain needed infrastructure, and
  • substantial financial incentives that funnel down to primary care physicians and their staff members.

Inclusion of Risk Adjustment

In addition to the recommendations above, the draft paper's authors also called for

  • a national data infrastructure to "collect, use and report clinically rich and patient-reported data";
  • a measurement system that would reward improvement, promote the sharing of best practices, and "avoid a forced curve that mandates winners and losers"; and
  • performance measures that adhere to good measurement science.

Speaking to that last point, Wergin noted the AAFP's full support for proper risk-adjustment within measures.

"Risk-adjusting for socioeconomic status ensures the measures are fair and sets the standard for comparison of physician performance by adjusting for factors outside of the physician's control," he said."Physicians should not be penalized for taking care of more complex patients and higher risk populations. If this is not addressed in risk-adjustment, further disparities in care could be magnified."

Related AAFP News Coverage
AAFP Leads Move to Consistent, Meaningful Quality Measurement
Core Quality Measures Collaborative Announces New Core Measures Sets


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