Transformations to reduce quality measurement burden

To clear the way for innovation in family medicine practices, accelerate the escape from fee-for-service care, and truly alleviate administrative complexity, the AAFP advocates for state and federal policies that encourage and reward practice transformation.

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Why quality measurement needs reform

Complexity and fragmentation of current quality metrics

On average, family medicine practices contract with 10 different payers. Tracking and successfully reporting different measures for each payer creates confusion and additional reporting burden and can actually undermine meaningful practice improvements.

Quality measurement has become a high-burden, high-cost administrative exercise, focused on financial concerns with little benefit to patient care, population health and cost reduction.

Aligning measures across payers would help to identify disparities in care quality (and, in some cases, utilization and access) across different payers, states and lines of service. Greater alignment also would drive improvements in data collection automation, which would reduce reporting burden on family physicians and other clinicians.

Impact on physician workload and innovation

Studies have estimated that primary care physicians spend nearly half their time on administrative tasks. Many practices must hire dedicated staff to submit claims or prior authorization requests. The volume of administrative burden contributes to physician burnout, placing significant financial strain on primary care practices, and ultimately impeding physicians' ability to deliver high-quality and timely patient care.

Strategies to reduce administrative burden

The AAFP leverages a multi-prong strategy to reduce administrative burden, with five main areas of focus.

  1. Constructing the right measures
    The AAFP does not itself develop measures, but it advises developers and stakeholders to ensure that the voice of family medicine is heard. The AAFP nominates its members as representatives to external groups (more than 50 work groups and panels) that develop and endorse measures and respond during measure comment periods. The Academy also participates in Primary Care Measures That Matter, and the Partnership for Quality Measurement.

  2. Harmonizing across payers
    A large contributor to the quality measurement burden is the variation of measures used across payers. The AAFP participates in multiple efforts to harmonize quality measures, such as the Core Quality Measures Collaborative (CQMC) and CMS’ Universal Foundation. The CQMC is a public-private, multi-stakeholder effort working to define core measure sets for various specialties. With significant input from the AAFP, it developed an Accountable Care Organizations and Patient Centered Medical Home/Primary Care Core Measure Set for primary care. Harmonization has begun, but more work is needed.

  3. Standardizing measures and reporting
    The AAFP participates in several efforts working on standardizing measures and the interoperability needed for capturing data and reporting measures. The Academy provides the family medicine voice in national efforts to standardize quality data, including the National Quality Forum, USCDI+Quality, the Da Vinci Project, CQMC and others.

  4. Aligning approaches to measure models
    The AAFP participates in CQMC work groups and is among more than 70 member organizations helping to address the proliferation of measures by facilitating cross-payer measure alignment through the development of core sets of measures by clinical area to assess the quality of U.S. health care.

  5. Limiting to essential measures
    The AAFP advocates for federal and private-payer policy a policy limiting the number of quality measures that must be reported by primary care. The Academy also is focused on driving toward measures that truly gauge the value of primary care, including new measures focused on the 4 Cs of First Contact, Continuity, Coordination and Comprehensiveness.

The AAFP’s role in driving change

The Academy’s vision of a quality measurement strategy for primary care centers on the creation of large data stores and advances in technology changing the fundamental process of measurement and improvement.

Achieving this vision would drive large-scale improvements in health, health care and cost reduction. The Academy:

  • distinguishes between quality measures that are used for internal quality improvement efforts and those used for value-based payment and public reporting because the intended use determines the focus of measures and the rigor with which criteria of importance, measurability and achievability are applied;

  • addresses the leadership role of physicians, the critical role patients and caregivers have in quality measurement and improvement and the equalization of the partnership between patients/caregivers and clinicians, enabled by more actionable information and sophisticated primary care teams;

  • considers the importance of systems-level attribution and measurement, shared responsibility for outcomes and community involvement in improvement efforts; and

  • discusses the most important features of primary care that are responsible for improved outcomes and lower costs.

Future efforts to develop measures for primary care should be directed toward these areas.