A new study from the American College of Physicians Performance Measurement Committee rated as valid only 37 percent of the 86 Quality Payment Program measures for 2017 deemed relevant to ambulatory general internal medicine. Thirty-five percent were rated not valid and 28 percent as of uncertain validity.
The study, published in the New England Journal of Medicine, noted that “although most physicians view the delivery of high-quality care as a professional imperative, performance-measurement activities face increasing resistance from physicians and some policymakers who believe that current measures are not meaningful.”
In response to these concerns, the ACP’s Performance Measurement Committee developed criteria to assess the validity of performance measures, using a modified version of the method developed at RAND and UCLA for evaluating the benefits and harms of a medical intervention.
Among the 30 measures rated as not valid, 19 were judged to have insufficient evidence to support them. For example, MIPS measure 181, “Elder Maltreatment Screen and Follow-Up,” requires the completion of the Maltreatment Screening tool on the date of an encounter and a documented follow-up plan for all patients 65 years of age or older. The ACP report states that although elder abuse is a serious problem that physicians should appropriately diagnose and report, the U.S. Preventive Services Task Force has found insufficient evidence to warrant routine screening. “We believe the substantial resources required to screen large populations of elderly patients for maltreatment and to track follow-up would be better directed at care processes whose link to improved health is supported by more robust evidence,” the report says.
Besides doing their own assessment on the validity of MIPS measures, ACP also determined the proportion of the measures that had been developed by the National Committee for Quality Assurance (NCQA) or endorsed by the National Quality Forum (NQF) that were rated as valid by its method. As compared with measures that were not endorsed by these organizations, greater percentages of NCQA-developed and NQF-endorsed measures were deemed valid (59% and 48%, respectively, vs. 27% for non-endorsed measures), and smaller percentages were deemed not valid (7% and 22%, vs. 49% for non-endorsed measures).
In its conclusion, the ACP paper states that the fact that only 37% of the MIPS measures were found to be valid with a standardized method has implications for physician-level performance measurement. “The use of flawed measures is not only frustrating to physicians but also potentially harmful to patients,” they wrote. "Moreover, such activities introduce inefficiencies and administrative costs into a health system widely regarded as too expensive.”
The paper suggests that a more rigorous method of assessing measures’ validity could help identify issues before the measures are launched.
In March, Healthcare Informatics covered a proposal by the Medicare Payment Advisory Commission (MedPAC) that federal legislative leaders eliminate MIPS and replace it with an alternative model of reimbursement.
In that article, Tim Gronniger, senior vice president of strategy and development at Kansas City-based Caravan Health, a builder of accountable care organizations, noted that MedPAC gave voice to many of the concerns and frustrations that clinicians have about MIPS. “The core problem with MIPS is there is a disconnect between what clinicians feel like is important for their practice and what we can actually measure in the practice. Many feel that it’s a lot of work for not a lot of benefit to patients.”
