When Measuring Health Care, Less Is More

To its credit, the Centers for Medicare and Medicaid Services has recognized that the movement to pay for value in health care has created unintended consequences. The costly, inefficient process of measuring, collecting and reporting data on the performance of health care providers is hampering the ability to deliver high-quality patient care.

Providers “are spending so much time and energy reporting, when what we need providers to do is focus on patients,” said CMS Administrator Seema Verma at a recent speaking engagement in Washington, D.C. “We need people on the front lines, not in the back room behind a computer screen.”

CMS heard this complaint in public comments about regulatory burdens on health care providers solicited in 2017. So have I. As president and chief executive officer of AMGA, I work with more than 440 multispecialty medical groups and health systems across the nation, representing 175,000 physicians. Our members currently are required to report hundreds of different quality measures to various government and commercial payers, many of which are not useful in evaluating or improving the quality of care provided.

In a survey last fall and in conversations, our members have told us that reporting duplicative measures in divergent formats to many payers is not only a significant obstacle in moving to value, it is also contributing to the serious problem of physician burnout. The resource drain is not insignificant: Research has indicated that, on average, U.S. physician practices across four common specialties annually spend more than $15.4 billion and 785 hours per physician to report quality measures.  

With this in mind, we formed a clinician-led task force, chaired by Dr. Scott Hines, chief quality officer of Crystal Run Healthcare, and developed a streamlined set of 14 measures that reflects the collective expertise of integrated systems and multispecialty medical groups that are leading the move to value-based care. Endorsed by AMGA’s board in late June, the measures are evidence-based, focused on outcomes and clinically relevant.

This value measurement set includes emergency department use, functional status, skilled nursing facility admissions, hospital readmissions, diabetes, depression, hypertension care, cancer screenings, pneumonia vaccination, pediatric care and patients’ health status. It also includes both process measures, such as cancer screening and immunization rates, which focus attention on quality improvement and outcome measures, which emphasize the need to evaluate how care is provided to best drive better patient health.

It is important to note that this set is not intended to replace all other measures but instead serve as a standardized set for public reporting purposes. There are a host of other measures used to drive quality improvement within health care provider organizations that capture important aspects of care but do not necessarily reflect system performance.

We hope to see CMS and commercial insurers embrace these measures for value-based contracts, such as accountable care organizations, where they will streamline the measures that must be reported and help eliminate unnecessary confusion and administrative burden so frontline physicians can focus on delivering high-quality patient care.

Evaluating the performance of providers is a prerequisite for value-based care and contracting, not an end in itself. We join CMS’ call to keep the health care system’s energy and attention focused on patients, not computer screens. This is one case where less can truly be more for patients.


Jerry Penso, M.D., M.B.A., is president and chief executive officer of AMGA.

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