Abstract
Barry Saver and colleagues caution against the use of process and performance metrics as health care quality measures in the United States.
Highlights
Accountable Care Organization (ACO) quality measures not created by Centers for Medicare and Medicaid Services (CMS) carry the disclaimer that “These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications” [25]
When sponsors attach such disclaimers to their metrics, it is appropriate to question their use in public reporting and financial incentives
Just as the Paperwork Reduction Act in the US requires an accounting of the time required for form completion, quality measures should include an estimate of the costs they will require
Summary
Despite recent flaws in implementing measures for Accountable Care Organizations (ACOs), the Centers for Medicare and Medicaid Services (CMS), which administers national health care programs in the US, is moving towards linking 30% of Medicare reimbursements to the “quality or value” of providers’ services by the end of 2016 and 50% by the end of 2018 through alternative payment models [5]; more recently, CMS announced a goal of tying 85% of traditional fee-for-service payments to quality or value by 2016 and 90% by 2018 [6] Earlier this year, the Medicare Payment Advisory Commission cautioned that “provider-level measurement activities are accelerating without regard to the costs or benefits of an ever-increasing number of measures” [7].
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