May 19, 2022, 9:30 a.m. David Mitchell — For years, family physicians have been asking for help with administrative burden and payment. Rebecca Etz, Ph.D., thinks help is on its way on both fronts in the form of a measurement made specifically for primary care that could replace other quantifications.
“Primary care is in a strange position of having too many measures applied to it and also not enough that matter,” said Etz, professor of family medicine and population health at the VCU School of Medicine and co-director of The Larry A. Green Center. “Most practices report on more than 100 measures, but very few of those apply to the purpose and function of primary care. They don’t reflect what primary care does. This measure was created to address both issues.”
Etz led the Green Center’s efforts to develop the Person-Centered Primary Care Measure, a patient-reported outcome measure. The PCPCM is part of the Center for Professionalism & Value in Health Care’s Measures That Matter initiative, in which the AAFP participates as a partner. Etz said the PCPCM could eventually “drastically reduce” the number of other measures used.
“That would be a huge win for primary care,” she said.
The PCPCM is an 11-item patient-reported measure to assess primary care aspects that, according to the Green Center, are “rarely captured yet thought responsible for primary care effects on population health, equity, quality and sustainable expenditures” that include accessibility, comprehensiveness, integration, coordination, relationship, advocacy, family and community context, goal-oriented care, and disease, illness and prevention management.
“My wish is that it would replace other measures because we are measuring the wrong things,” Etz said. “There are too many measures focused on disease and disease pathways, and that’s not appropriate for primary care. It’s not appropriate for 80% of what we do in primary care.”
The PCPCM was originally introduced in 2019 but has been featured recently in March and May FPM supplements that explain what it is, how it works and how to implement it. The PCPCM can be used by primary care practices for quality improvement and by employers and health plans for performance measurement in value-based payment arrangements.
“Most people would like to know if payers are interested and considering it, and can it be used in the Merit-based Incentive Payment System; the answers are yes and yes,” said Etz, who noted that the measure has been endorsed by CMS and the National Quality Forum. “Payers are very interested.”
Anthem is piloting the measure in Colorado and Indiana, and Blue Cross Blue Shield has a pilot in Massachusetts, she said, and state-level studies are set to begin in Virginia and Maryland.
Michael LeFevre, M.D., chair of the Department of Family Medicine at the University of Missouri School of Medicine, said existing measures don’t capture the complex, longitudinal nature of primary care.
“We need to be measured in ways that are different from a cardiologist,” he said.
In the May FPM supplement, LeFevre shared his experience implementing the measure in an academic system with 60 physicians, 42 residents and 11 mid-level clinicians serving 60,000 patients at nine locations. He said the new person-centric measure is more appropriate for primary care.
LeFevre said one selling point of the PCPCM is that patients are surveyed just once a year during their birth month. That strategy gives clinicians year-round feedback, and patients are asked to consider their overall, ongoing care experience rather than a specific encounter. He said that approach is “by far preferable” to existing patient surveys that “hammer them after every visit.”
“Patients are over-surveyed,” he said, noting that too many surveys can hamper patient response rates.
The PCPCM is designed to be easy to implement with little to no added expense. The University of Missouri School of Medicine’s patient experience survey vendor agreed to distribute the PCPCM at no additional cost.
LeFevre said the NQF endorsement was an important first step to expanding the PCPCM’s use, but other challenges await. One limitation, he said, is that many family physicians are employed by large health systems that may be reluctant to survey patients “just for primary care.”
Missouri’s family medicine department implemented the PCPCM in 2020 because it offered a better way to measure care, LeFevre said, but the school continues to use existing measures — for now.
“We’re not quite there yet,” he said. “(Our) payers aren’t quite with us.”
The AAFP is advocating for adoption of the PCPCM in performance-based contracts, and the May FPM supplement noted family physicians and family medicine practices can play an instrumental role in efforts to implement the measure by asking for it to be included in their performance-based contracts.