- The American College of Physicians, responding to provider concerns about current performance measurement policies, published an analysis of the Merit-based Incentive Payment System in the New England Journal of Medicine and found the majority of measures for ambulatory internal medicine are not valid by the ACP's own criteria.
- Of the 86 performance measures included in MACRA's MIPS track and Quality Payment Program, ACP deemed 32 to be valid, 30 to be not valid and 24 of "uncertain validity."
- ACP cited the National Academy of Medicine's clinical practice guidelines as a model for setting a single set of standards that would allow performance measures to be properly assessed before being put into practice.
With this paper, ACP joins other prominent groups questioning the validity and positive impact of MIPS and QPP. The Medicare Payment Advisory Commission has pushed for complete MIPS repeal, suggesting instead a new program that withholds a portion of payments to create a rewards pool. The authors of the ACP paper, however, are not suggesting repeal.
"We're saying there's a real problem with the measures," Catherine MacLean, co-author of the paper and chief value medical officer at Hospital for Special Surgery in New York City, told Healthcare Dive. "I don't think there's a problem per se with MIPS. What we're calling out is many of the measures in MIPS are problematic, and we need to fix those measures."
A Medical Group Management Association (MGMA) survey published last year also found that group practices feel MIPS is too complex and hinders patient care. Nearly three-fourths (73%) of those surveyed by said MIPS doesn't support clinical quality priorities and found it to be "very" or "extremely" complex.
This ACP paper concurs, noting that the use of flawed measures frustrates physicians is "potentially harmful to patients" and comes with a price tag. According to ACP, physician practices spend about $40,000 a year per physician to report on performance, with a majority of physicians claiming current measures fail to adequately capture the quality of care they provide patients.
The authors note that a common characteristic among the 30 performance measures rated as "not valid" was inadequately specified exclusions resulting in "a requirement that a process or outcome occur across broad groups of patients, including patients who might not benefit." Additionally, 19 of those 30 invalid measures, according to ACP's own criteria, were not backed up by sufficient evidence.
MacLean said certain measures, like one that requires patients with high blood pressure to have it managed at a target of 140/90, are not manageable goals for older patients. "Doctors with older patients will fail that measure," she said. "They just aren't going to treat to that standard because it's not the right thing to do for their patients."
ACP called for more flexibility in future performance measurement systems, and advised policymakers to implement standards that aren't "limited by the use of easy-to-obtain data" and that function "as a stand-alone, retrospective exercise."
Performance measures should be fully integrated into care delivery so they can help to address the most pressing performance gaps and direct quality improvement," ACP President Jack Ende said in a statement.
A future solution, Ende said, could be developed using "clinically relevant methodology" by physicians who have expertise in clinical medicine and research.
MacLean said the ultimate goal is to improve the health of the population, and that requires transparency about quality. Consumers should be able to know the quality of a provider and make a choice based on that specific information.
"We need to take a step back, look at these measures and think about two things," MacLean said. "One, what matters to patients in terms of improving their quality of life. Two, when we do that quality measurement, how do we do it in a way that's useful for physicians?"
CMS recently announced a new funding opportunity for the development, improvement and expansion of quality measures for QPP. The agency said it will provide up to $30 million in funding and technical assistance to clinicians, patients and other stakeholders working on performance measures over the next three years.