Blog | Wednesday, February 18, 2015

Performance measurement has major problems


I started writing about performance measurement and associated problems for 10 years. For the first few years, we in the blogosphere seemed to be shouting in the wilderness.

When I first joined the ACP Board of Regents, the general consensus favored pay for performance. We who questioned the value of performance measures were told that “the train has left the station.”

Over the past 7 years, many leaders in medicine have seen what the blogs saw first, we have too many bad measures, and too often performance measurement has significant unintended consequences.

Now even MedPac has major concerns about the proliferation of performance measures.

Over the past few years the Commission has become increasingly concerned that Medicare's current quality measurement approach is becoming “over-built,” and is relying on too many clinical process measures that are, at best, weakly correlated with health outcomes. Depending on a large number of process measures reinforces undesirable payment incentives in fee-for-service Medicare to increase the volume of services and is overly burdensome on providers to report, while yielding limited information to support clinical improvement or beneficiary choice. Instead the Commission has urged more focused attention on a small number of population-level outcome measures, such as potentially avoidable hospital admissions, emergency department visits, and readmissions.

When MedPac complains to CMS we must have reached a “tipping point.” The current approach to performance measures is actually harmful. The ACP Performance Measurement Committee is endorsing approximately 20% of proposed measures. Most measures have inadequate data supporting them. Too many proposed measures read like expert opinions.

Bravo to MedPac for making this letter public. Now we can only hope that CMS will listen.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.