On Quality Measures, We’ve Picked Quantity Over Quality
We have adopted the flawed mantra that ‘more data is better’. Medicare collects data on more than 1,700 quality metrics – and each state Medicaid agency and commercial payer tracks even more measures. Medicare quality tracking alone racks up an estimated $15.4B in costs annually and requires more than 15 hours of practice time per physician per week. If practices regularly reviewed their data to identify and act on opportunities for improvement, this tracking might be worth it. However, only 30 minutes of those 15+ hours are spent reviewing data. Physicians reported reviewing their quality data for a grand total of 6 minutes per week – how can you possibly improve if you only spend 6 minutes thinking about them?
A better approach could be to pick a few metrics, set targets, and hold everyone to them. No matter how good a physician is, they cannot keep dozens of different quality metrics straight, let alone a health system or payor trying to manage 1,700. Patients seem to rarely look at the data based upon the lack of market share movement linked to quality metric results – and most metrics aren’t even public. Instead, let’s agree on a few universal metrics that are evidence-based, tracked already, impact a lot of people, and that providers can do something about. We should set aggressive targets backed by science – and dedicate concentrated resources to improving performance dramatically.
We have done this before – and it works. The U.S. government declared a war on hospital-acquired infections (HAIs) in 2008, and through a series of Medicare reimbursement changes, educational campaigns, and public advocacy, we have been very successful. By 2016, we reduced the rate of central line-associated bloodstream infections by nearly half. Similarly, we halved the number of catheter-associated urinary tract infections. We didn’t need a miracle cure – just good science, supportive policy, quality data, strong incentives and a commitment to doing something about it.
By 2025, we can do a lot. I recommend four primary care metrics to focus on first:
We can do the same thing for specialists. For OBGYNs, target maternal mortality rates. For cardiologists, congestive heart failure readmission rates. Of course, these metrics need to be risk-adjusted to the clinician’s panel – and for some specialties, we’ll use metrics at the practice or facility level, given the relatively low incidence of certain outcomes.
This isn’t perfect, but it is likely better at driving improvement than our current system. There’s room to debate which metrics to use and what targets to set. Maybe instead of 4 measures, it should be 6, or 10, or 17 – but the magic number certainly isn’t 1,700. Tomorrow’s healthcare ecosystem will need to be more innovative, adaptable, and strategic when collecting and reporting data – a standard that other industries met decades ago. When it comes to quality metrics, let’s not allow quantity to get in the way of quality.