Misalignment of Healthcare Quality Measures Impacts Payers

October 14, 2016 - In the healthcare industry’s move toward value-based care reimbursement, public and private payers create healthcare quality measures meant to align with how providers are paid and what type of financial penalties will be instituted for poorer quality.  A report from the US Government Accountability Office (GAO) finds a fair share of misalignment regarding healthcare quality measures among payers.

Among the several payers that hospitals and other healthcare systems must manage from Medicaid and Medicare to commercial insurers, many define healthcare quality measures using differing specifications or varying quality factors. Three specific issues drove the misalignment of healthcare quality measures, the GAO report found. These factors are varying data collection and quality reporting, multiple sources for decision-making, and an inadequate amount of meaningful healthcare quality measures.

When it comes to variation in data collection, health payers have the ability to choose different measures and change certain healthcare quality measures or not specify some factors sufficiently. All of this leaves providers with an inability to report on healthcare quality measures in a logical, organized manner. 

Additionally, dispersed decision making on quality benchmarks occurs when multiple payers from the private to the public sector have multiple voices. Multiple entities have created an environment of separate decision making for healthcare quality measures including the Joint Commission, the National Committee for Quality Assurance, and other medical associations. Dispersed decision making further brings excessive administrative burden on healthcare providers, GAO reports. 

However, the Department of Health and Human Services (HHS) has been negotiating with commercial payers to create and implement a core set of healthcare quality measures.

With large variation in data systems, HHS will also be working to create electronic quality measures and bring more standardization for data collection using these quality benchmarks.

The report’s finding that few meaningful healthcare quality measures exist is seen from the payers, providers, and stakeholders who adopt small numbers of these benchmarks, claiming that few of the hundreds of quality measures created lead to meaningful improvements for patient care and outcomes.

The Centers for Medicare & Medicaid Services (CMS) has gone forward in addressing some of these concerns and have worked to bring more meaning to healthcare quality measures by considering “key quality concerns,” the report stated. However, the GAO report finds that CMS may struggle to address the misalignment of quality measures.

“CMS’s efforts to develop new, more meaningful quality measures may not lead to greater measure alignment due to a lack of comprehensive planning. Increasing alignment across the measures used by federal and private payers is one of the objectives explicitly stated in CMS’s Quality Measure Development Plan, but a broad range of other objectives are listed there as well,” the GAO report stated. 

“They include providing clinically relevant measures for all medical specialties; creating more measures focusing on outcomes, especially patient reported outcomes; supporting improved integration of physical and behavioral health; assessing team-based care; and fully engaging the perspectives of patients and their caregivers in measure development. The plan provides no clear indication of how CMS’s ongoing measure development efforts will help CMS to achieve its goal of reducing measure misalignment, such as through the development of new quality measures that are most likely to help promote quality measure alignment among federal and private payers,” the study concluded.

The GAO report incorporates a literature review of trade association publications, peer-reviewed journals, government findings, and conference white papers that were published from January 2010 to February 2016. The GAO researchers identified 13 studies for the report and interviewed HHS officials as well as professionals from 16 organizations.

Both an excess of time and finances have been spent on reporting healthcare quality measures among healthcare providers across the nation. A report published in Health Affairs found that medical professionals including cardiologists, orthopedists, internists, and primary care doctors are spending more than $15.4 billion annually for quality benchmark reporting.

“The cost to physician practices of dealing with quality measures is high and rising,” the researchers stated in their paper. “There is much to gain from quality measurement, but the current system is far from being efficient and contributes to negative physician attitudes toward quality measures.”

Additionally, the research shows that more than 700 hours per physician has been spent to report on quality measures. In monetary terms, this means that about $40,000 is spent on each doctor to complete these tasks every year. Both staff and physicians spent more than 15 hours per week on collecting healthcare quality data. On average, an individual doctor spends 2.6 hours per week managing quality measures, the study found.

The reason that providers spend so much time and money on reporting quality measures may be tied to the misalignment of these benchmarks among payers. The entire reporting process could be streamlined if public and private payers come together to address the issues found in the GAO report.

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