A different way to measure primary care performance

Have you ever felt surrounded by something, but unable to benefit from it (“Water, water everywhere, and not a drop to drink”)? For many primary care physicians, this may be a good description of performance measures.

Despite massive amounts of measures, few are currently evaluating the key functions of primary care that patients, communities, and health systems value most. In 2017, the Starfield III: Meaningful Measures for Primary Care summit assembled 70 national and international stakeholders to move primary care measures beyond disease-specific criteria to those that capture the unique features of primary care most responsible for better outcomes and lower costs.

The ideas produced at that summit allowed the Larry A. Green Center to develop the Person-Centered Primary Care Measure, or PCPCM. The PCPCM is a “patient-reported outcome performance measure (PRO-PM),” or survey, of primary care quality that focuses on the patient’s access to care, relationship with the physician, and ability to reach health outcome goals. These measures recognize the patient as a valuable source of knowledge about many important aspects of care.

The PCPCM focuses on integrating, personalizing, and prioritizing care. Its eleven items (plus one optional question) form an evaluation of access, continuity, comprehensiveness, coordination, advocacy, family and community context, and goal-oriented care. These fundamental elements are associated with better health, equity, quality, and sustainable health care expenditures and are unique to primary care. Here’s the full survey:

Lower administrative burden

The PCPCM carries a low administrative burden for physicians, because all data is submitted by the patient. Responses may be automatically captured in the EHR or registry if collected electronically (such as through a patient portal), or clinic staff may enter responses if the survey is administered on paper. The survey is brief, has high face validity and transparency, offers opportunities for improvement, and is available in 28 languages. It has been extensively tested and the Centers for Medicare & Medicaid Services (CMS) accepted it in 2018 for use in the Merit-based Incentive Payment System (MIPS) as a Qualified Clinical Data Registry (QCDR) measure. It has been submitted for consideration as a high-priority patient experience measure within MIPS, as well. The National Quality Forum is also reviewing it for endorsement.  

More information about the PCPCM, including its relevance during the COVID-19 pandemic, is available in the Annals of Family Medicine. The article also discusses three other primary care-focused measures that, together with the PCPCM, may became the new core measures of primary care.

Implementing PCPCM

Physicians interested in using the PCPCM may download a Fielding and Reporting Kit from the Larry A. Green Center.

If you are working with a QCDR, request that it include the PCPCM in its offerings. Any QCDR can work directly with the PRIME registry to include the measure at no charge.

You can also ask your EHR vendor to include the PCPCM as a patient-reported outcome measure. This should be easy to achieve once it is available as a MIPS measure.

We’ll provide more guidance here in the future on how to use patient-reported outcome measures generated by the PCPCM, so watch for that.

— Sandy Pogones, Senior Strategist Health Care Quality, American Academy of Family Physicians