Physician Quality Reporting System Research Articles

Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance.

Lloyd R, Morgenthaler TI, Donald R, etal. Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance. J Clin Sleep Med. 2022;18(11):2673-2680.

Ophthalmologists in the First Year of the Merit-based Incentive Payment System

In 2017, the Medicare Access and Children’s Health Insurance Program Reauthorization Act began requiring clinicians providing services to Medicare Part B beneficiaries to participate in the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Model.1,2 MIPS was created by Medicare Access and Children’s Health Insurance Program Reauthorization Act to consolidate previous quality reporting systems, including the Physician Quality Reporting System (PQRS). This new program bases payment adjustments on quality performance, completion of improvement activities, and the use of electronic health records (EHRs).

Opioid prescription patterns among radiation oncologists in the United States.

BackgroundRadiation oncologists (ROs) play an important role in managing cancer pain; however, their opioid prescribing patterns remain poorly described.MethodsThe 2016 Medicare Physician Compare National Downloadable and the 2016 Medicare Part D Prescriber Data files were cross‐linked to identify RO‐written opioid prescriptions.ResultsOf 4,627 identified ROs, 1,360 (29.3%) wrote >10 opioid prescriptions. The average number of opioid prescriptions written was significantly (P ≤ .05) associated with the following RO characteristics: sex [13.1 ± 36.5 male vs 7.5 ± 16.9 female]; years since medical school graduation [4.5 ± 11.5 1‐10 years vs 12.6 ± 26.0 11‐24 years vs 13.3 ± 40.9 ≥25 years]; practice size [15.5 ± 44.6 size ≤10 vs 13.3 ± 25.9 size 11‐49 vs 8.5 ± 12.7 size 50‐99 vs 8.8 ± 26.9 size ≥100]; Medicare Physician Quality Reporting System (PQRS) participation [12.6 ± 31.8 yes vs 7.0 ± 35.4 no]; and practice location [17.4 ± 47.0 South vs 10.6 ± 29.4 Midwest vs 8.1 ± 13.9 West vs 6.9 ± 15.2 Northeast]. On multivariable regression modeling, male sex (RR 1.29, 95% CI 1.22‐1.35, P < .001), ≥25 years since graduation (RR 0.78, 95% CI 0.64‐0.70, 1‐10 years vs ≥25 years; RR 1.00, 95% CI 0.96 ‐ 1.04, 11‐24 years vs ≥25 years; P < .001), practice size <10 members (RR 1.51, CI 1.44‐1.59, ≤10 vs ≥100 members, RR 1.27, CI 1.20‐1.34, 10‐49 vs ≥100 members, RR 0.86, CI 0.80‐0.92, 50‐99 vs ≥100 members, P < .001), PQRS participation (RR 1.12, CI 1.04‐1.19, P < .002), and Southern location (RR 0.67, CI 0.64‐0.70, Midwest vs South; RR 0.39, CI 0.37‐0.41, Northeast vs South; RR 0.43, CI 0.41‐0.46, West vs South; P < .001) were predictive of higher opioid prescription rates.ConclusionsFactors associated with increased number of RO‐written opioid prescriptions were male sex, ≥25 years since graduation, group practice <10, PQRS participation, and Southern location. Additional research is required to establish optimal opioid prescribing practices for ROs.

Association of Patient-reported Experiences and Surgical Outcomes Among Group Practices: Retrospective Cohort Study.

The aim of the study was to determine the association of patient-reported experiences (PREs) and risk-adjusted surgical outcomes among group practices. The Centers for Medicare and Medicaid Services required large group practices to submit PREs data for successful participation in the Physician Quality Reporting System (PQRS) using the Consumer Assessment of Healthcare Providers and Systems for PQRS survey. Whether these PREs data correlate with perioperative outcomes remains ill defined. Operations between January 1, 2014 and December 31, 2016 in the American College of Surgeons' National Surgical Quality Improvement Program registry were merged with 2015 Consumer Assessment of Healthcare Providers and Systems for PQRS survey data. Hierarchical logistic models were constructed to estimate associations between 7 subscales and 1 composite score of PREs and 30-day morbidity, unplanned readmission, and unplanned reoperation, separately, while adjusting for patient- and procedure mix. Among 328 group practices identified, patients reported their experiences with clinician communication the highest (mean ± standard deviation, 82.66 ± 3.10), and with attention to medication cost the lowest (25.96 ± 5.14). The mean composite score was 61.08 (±6.66). On multivariable analyses, better PREs scores regarding medication cost, between-visit communication, and the composite score of experience were each associated with 4% decreased odds of morbidity [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92-0.99], readmission (OR 0.96, 95% CI 0.93-0.99), and reoperation (OR 0.96, 95% CI 0.93-0.99), respectively. In sensitivity analyses, better between-visit communication remained significantly associated with fewer readmissions. In these data, patients' report of better between-visit communication was associated with fewer readmissions. More sensitive, surgery-specific PRE assessments may reveal additional unique insights for improving the quality of surgical care.

Adherence to Clinical Guidelines, Electronic Health Record Use, and Online Reviews

To increase transparency of healthcare quality, the Centers for Medicare and Medicaid Services (CMS) initiated the Physician Quality Reporting System (PQRS). However, the impact of PQRS on physicians is unclear, particularly as related to their online reputation. Is there an association between a physician’s online reputation and her adherence to clinical guidelines stipulated in the PQRS? Is online reputation associated with use of electronic health records (EHR)? To investigate these questions, we combine data on online physician reviews with the PQRS data on clinical guideline adherence and EHR use. Unlike prior research, which primarily uses clinical outcomes as proxies for care quality, our study uses adherence to clinical guidelines, a process measure that reflects physician conformance with evidence-based clinical practices. In addition, we focus on EHR use at the physician level, in contrast to the usual approach of examining it at the aggregate institutional level. Consistent with the economic theory of credence goods, we observe no significant relationship between physicians’ adherence to clinical guidelines and their online reviews. Although there is some evidence of association between EHR use and their overall rating, similar relationships are not consistently observed for individual dimensional ratings. Overall, the online reputation of a physician exhibits minimal association with her actual clinical activities — and is mostly driven by latent topics in the textual reviews — implying that the ability of online reviews to inform prospective patients of care quality might be quite limited. Therefore, patients should be cautious when using online physician reviews, and policymakers should increase the accessibility of PQRS and other similar data to help patients make informed physician choices.

Sustained Improvement in Inflammatory Bowel Disease Quality Measures Using an Electronic Health Record Intervention.

Inflammatory bowel disease (IBD) is a chronic condition with wide variation in treatment and resource utilization because of many different disease presentations and treatment options. In an effort to standardize care and improve health outcomes, several organizations have created performance measures to monitor various aspects of IBD care. We aimed to assess longitudinal documentation adherence with physician quality reporting system's (PQRS) IBD performance measures before, immediately after, and 1 year following the implementation of a comprehensive electronic health record (EHR) IBD clinical documentation support tool intervention. We reviewed 50 patient charts that were randomly selected from consecutive outpatient IBD visits at our tertiary care center from September 1, 2015 to June 30, 2016, prior to implementation of an IBD-specific note template, order set, and patient education handout on September 1, 2016. Two additional cohorts of 50 patient charts were randomly selected from September 1, 2016 to June 30, 2017 and September 1, 2017 to June 30, 2018. These charts were reviewed to assess adherence of pertinent PQRS performance measures for outpatient IBD care. The project was deemed not human subjects research and received exempt approval by the Institutional Review Board (IRB#: IRB00040399). The cohort immediately after the intervention showed significant increases in documentation rates of influenza immunization (19-59%, p < 0.001), pneumococcal immunizations (2-38%, p < 0.001), tobacco cessation (28.6-77.8%, p = 0.049), and proportion of all eligible measures (40.6-62.2%, p < 0.001) when compared with the preintervention group. Moreover, documentation rates were sustained in the 1-year follow-up group when compared with the postintervention group. A multifaceted, EHR focused approach can significantly and sustainably improve documentation of outpatient IBD quality measures.

Pathologists’ Participation and Performance in the Medicare Physician Quality Reporting System

Abstract Objectives Public reporting of quality metrics has become increasingly important for pathologists to demonstrate excellence of care and to secure value-based payments from both public and private payers. This study evaluated the participation and performance of pathologists in the Medicare Physician Quality Reporting System (PQRS). Methods This study conducted a retrospective review of the Physician Compare data files from 2016. Specifically, pathologists enrolled in the Physician Compare Initiative were identified and merged with quality data using uniquely assigned National Provider Identifiers. Descriptive statistics and multiple logistic regression were performed using Stata (version 12.1) statistical software (StataCorp, College Station, TX). Results Among the 11,637 pathologists identified in the Physician Compare Initiative, 8,408 pathologists (73.3%) participated in the PQRS. Regression analysis indicated that female gender, foreign medical graduate (FMG), and a larger number of employees in the affiliated organization were associated with a lower likelihood of participating in the PQRS. To protect patient privacy, the Centers for Medicare and Medicaid Services (CMS) only released the quality metrics of 353 pathologists, which were computed based on 20 or more Medicare beneficiaries. The three most commonly reported quality metrics included PQRS#249 Barrett’s Esophagus, PQRS#395 Lung Cancer Reporting (Biopsy/Cytology Specimens), and PQRS#397 Melanoma Reporting. The mean performance rates for the three most common metrics were 98.8% (SD 8.3%), 96.8% (SD 11.9%), and 97.4% (SD 6.9%), respectively. Conclusion A majority of pathologists participated in the Medicare PQRS program in 2016. The performance rates of public available quality metrics remained at high levels with significant variations in some metrics. Future research should examine the quality performance of pathologists as they transition from the PQRS to the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program.

Opioid Prescribing Patterns Among Radiation Oncologists in the United States

Although radiation oncologists (ROs) play a significant role in managing cancer-related pain, their opioid prescribing patterns remain poorly described. The aim of this study was to assess whether RO's opioid prescribing behavior would be associated with certain physician and practice characteristics. We identified 4,627 ROs in the 2016 Medicare Physician Compare National Downloadable File. Using National Provider Identifiers, data from this file were cross-linked with the 2016 Medicare Part D Prescriber data, thereby permitting identification of RO-written Medicare prescriptions. The following information was extracted for each RO: number of opioid prescriptions written, gender, years since medical school graduation, group practice size, use of electronic health record, participation in the Medicare Physician Quality Reporting System (PQRS), and practice location. T-tests were used to evaluate associations between ROs’ prescribing behavior and physician and practice characteristics. Multivariable linear regression was performed to identify factors independently associated with the number of opioid prescriptions written. Of the 4,627 ROs, 3,405 (73.6%) were male and 1,222 (26.4%) were female. In 2016, 2,850 (61.6%) ROs wrote more than 10 opioid prescriptions, most commonly hydrocodone with acetaminophen (n=23,577), oxycodone (n=10,226), oxycodone with acetaminophen (n=5,310), fentanyl (n=4,436) and morphine (n=2,161). The average number of opioid prescriptions written per RO was significantly (p≤ 0.05) associated with the following physician and practice characteristics: gender [13.1 (Standard Deviation (SD) 16.9) male vs. 7.5 (SD 36.5) female], years since medical school graduation [10.1 (SD 22.8) <24 years vs. 13.3 (SD 40.9) >24 years], group practice size [8.7 (SD 27.4) for size >138 vs. 13.3 (SD 33.8) for size <138], PQRS participation [12.6 (SD 31.8) yes vs. 7.0 (SD 35.4) no], and practice location [17.4 (SD 47.0) South vs. 10.6 (SD 29.4) Midwest vs. 8.1 (SD 13.9) West vs. 6.9 (SD 15.2) Northeast]. On multivariable linear regression, male gender (β +4.3, p<0.001), smaller group practice size (β +4.1, p<0.001), PQRS participation (β +5.5, p<0.001), and Southern practice location (β -5.2 Midwest, β -7.5 West, β -8.6 Northeast, p<0.001) predicted for higher opioid prescription rates. More than 24 years since medical school graduation (β +1.7, p=0.07) trended towards predicting higher opioid prescription rates. Opioid prescription behavior was associated with gender, practice group size, participation in PQRS, and practice location. Additional studies are needed to understand why male ROs write opioid prescriptions at nearly double the rate of female ROs and to identify specific recommendations for reducing opioid overprescribing while maintaining pain management options for cancer patients.

Antibiotic Use and Computed Tomography Imaging for Rhinosinusitis as Quality Metrics in Modern Health Care.

Background American Academy of Otolaryngology-Head and Neck Surgery rhinosinusitis guidelines have been adapted into quality measures intended to be a basis for adjusting physician reimbursement and as public information to help patients select physicians. Early and continual evaluation of these measures is therefore important, given the impacts these may have. Objective To examine the metrics used in by Medicare for reimbursement in the Physician Quality Reporting System (PQRS) used in Merit-based Incentive Payment System (MIPS). Methods This study is a retrospective review of the 2015–2016 Center for Medicare and Medicaid Services Physician Compare Initiative regarding quality metrics for acute and chronic rhinosinusitis for providers participating in MIPS. Results Data for 726 providers were extracted from the PQRS database. Otolaryngologists had a low enrollment with less than 50 responding for any 1 measure. Of the reported quality metrics, otolaryngologists prescribed a significantly greater number of antibiotics than other providers within 7 days of diagnosis or within 10 days after symptom onset (48.3% vs 11.3%, P &lt; .001). There was a significant difference in the mean compliance between otolaryngologists and all other providers for the use of CT scans within 28 days of diagnosis (2.3% vs 0.2%, P &lt; .001). There was no significant difference in the mean compliance for the use of multiple CT scans within 90 days of diagnosis (2.0% vs 2.3%, P = .8). Inverse metrics comprise 3 out of 4 measures. Conclusion This review of the quality metrics used in MIPS shows several differences between otolaryngologists and nonspecialists, but raise concerns regarding applicability.

Radiologist Group Performance Reporting: Power in Numbers

PurposeRadiologists have historically participated as individuals in CMS pay-for-performance programs, but little is known about how radiologists perform under increasingly available group participation. We aimed to assess radiologists’ relative national performance on CMS quality metrics using group versus individual participation. MethodsRadiologists’ group- and individual-level 2016 performance on Physician Quality Reporting System (PQRS) and non-PQRS Qualified Clinical Data Registry (QCDR) measures were obtained from the CMS national Physician Compare database and compared. ResultsRadiology groups reported an average 4.6 ± 2.0 quality measures; individual radiologists reported 2.3 ± 1.2 (P < .001). At least six measures were reported by 31.5% of groups versus 1.0% of individuals. Only one measure was reported by 5.4% of groups versus 33.0% of individuals. Groups reported 21 unique measures (20 via registries and one via QCDR). For 8 of the 11 measures reported by 20 or more groups, the average group performance rate was 3% or better than the average performance rate among radiologists participating as individuals (maximum 14% improvement with group participation versus individual participation for any individual measure). Group and individual performance were similar for the remaining three such measures. For measures reported by 20 or more groups in which a higher score indicates better performance, average group performance rates ranged from 86.2% to 98.9%. ConclusionCompared with individual participation in CMS quality performance programs, radiologists participating as a group reported larger numbers of quality measures and achieved higher performance rates on those measures. Radiology practices seeking success under Medicare’s new Quality Payment Program should carefully explore group participation.

Evaluation and identification of protocols for safe and efficacious institutional administration of intravenous immune globulin in hypogammaglobulinemia associated with chronic lymphocytic leukemia, non-Hodgkin lymphoma, and multiple myeloma.

250 Background: Hematologic malignancies effect both humoral and cell-mediated immunity. We hypothesize that for patients with Chronic Lymphocytic Leukemia (CLL), Non-Hodgkins Lymphoma (NHL), and Multiple Myeloma (MM) outcomes improve with adherence to National Comprehensive Cancer Network (NCCN) guidelines for intravenous immunoglobulin (IVIG).Our objective is to understand resource allocation and implementation of IVIG in outpatient and inpatient settings. We identified a cohort of patients with hypogammaglobulinemia for assessing incidence of sepsis, outcomes, and resource use. We initiated this project by undertaking a large descriptive study of current IVIG use. Methods: A retrospective Institutional Review Board (IRB) approved data capture was conducted covering 2016-2018. Inclusion criteria involved those on an active chemotherapy plan, age &gt; 18 years and diagnosis of CLL, NHL, or MM. IgA deficiency, anaphylaxis to IVIG, planned chemotherapy, inherited immunodeficiency, and thymic deficiency were excluded. We considered patients to be suitable for IVIG if IgG was &lt; 500 mg/dL for CLL and MM and &lt; 400 mg/dL in NHL. Outcomes, number of admissions, sepsis, ICU care, infectious etiology, and monthly IgG levels were examined. Results: A preliminary i2b2 data capture identified a cohort of 563 patients that yielded 12% with bacteremia, 21% with sepsis, and 23% with pneumonia of which 87% were admitted. 28% received IVIG during the 2-year period. Of the 563, 77% were hospitalized and 21% required ICU care. 54% of ICU patients received inpatient IVIG. All influenza and parainfluenza cases were inpatient. Final data analysis will yield greater detail in comparing inpatient to outpatient IVIG use. Conclusions: Large academic institutions appear to have significant variability in use of IVIG in patients with lymphopenia and hematologic malignancies. With this data, we plan to assess for patient-level outcomes based on adherence to NCCN guidelines as a way to enhance Physician Quality Reporting System (PQRS) standards by prioritizing outpatient use of IVIG.

Utilizing the Electronic Health Record to Improve Documentation Adherence With Performance Measures in Outpatient Inflammatory Bowel Disease Care

Inflammatory bowel disease (IBD) is a chronic condition leading to significant health, lifestyle, and cost burdens to patients, their families, and society. Several health care organizations, including The Physician Quality Reporting System (PQRS), have created performance measures to aid in establishing evidence-based standards of care in attempts to improve the quality of IBD care, and ultimately health outcomes. When used effectively, the electronic health record (EHR) should improve adherence to, and documentation of, performance measures for outpatient IBD care. The aim of this study was to assess documentation adherence with selected PQRS performance measures at one academic medical center before and after the implementation of an IBD order set, note template, and patient education handout into the EHR. Fifty patient charts were randomly selected from consecutive outpatient IBD visits at our medical center from September 1, 2015 to June 30, 2016, prior to the availability of the EHR improvements. Another 50 patient charts were randomly selected from consecutive outpatient IBD visits at our medical center from September 1, 2016 to June 30, 2017, just after the addition of the EHR improvements. These charts were reviewed to assess documentation adherence with the pertinent PQRS performance measures for outpatient IBD care, which included the following: documentation of influenza and pneumonia vaccination, tobacco screening and cessation education, evaluation of latent tuberculosis and hepatitis B status prior to the initiation of anti–tumor necrosis factor therapy, and bone loss risk assessment. Documentation of administration, refusal, or prior receipt of both the influenza (19.4% before, 59.5% after; P < .05) and pneumonia (9% before, 63.6% after; P < .05) vaccines improved after the addition of the IBD-specific EHR resources. In addition, documentation of tobacco cessation intervention improved from 28.6% to 77.8% (P < .05). During both the pre- and post-intervention chart reviews, compliance with documentation of testing for latent tuberculosis (66.7% before, 100% after) and hepatitis B virus serology (100% before, 100% after) prior to the initiation of anti–tumor necrosis factor therapy and screening for tobacco use (100% before, 100% after) was high during both periods of time. Documentation of patients at risk for bone loss related to steroid use (0% before, 12.5% after) remained low both before and after the EHR improvements. None of these measures met statistical significance. The availability of customizable electronic resources in the EHR improves documentation compliance of PQRS measures for outpatient IBD care.

Family medicine and physician reimbursement: a US perspective and the RCGP International and Overseas Network.

This article highlights a significant issue that will change the landscape of the US healthcare for decades to come: the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of April 2015 (MACRA).1 MACRA heralds a rare opportunity for the US healthcare delivery system to revamp the way it reimburses physicians, with a pivot from a volume-based payment system to one of quality and value. MACRA essentially is designed to reward or penalise physicians for patient care services that have been provided. This legislation established the Quality Payment Program (QPP) which is the overarching term for the two tracks through which Medicare payments would be made: merit-based incentive payment system (MIPS), and advanced alternative payment models (advanced APMs).2 The QPP aims to improve health outcomes, promote smarter spending, minimise burden of participation, and provide fairness and transparency in operations.3 It replaces Centers for Medicare & Medicaid Services legacy programmes for clinician quality reporting, including the physician quality reporting system (PQRS), the value-based payment modifier (VBPM), and the Medicare Electronic Health Records (EHR) Incentive Program for Eligible Professionals, to support the transition to value-based care and healthcare delivery system reform.3–6 Physicians and other providers are critical to the success of MACRA.7 …

Incorporation of Scribes Into the Inflammatory Bowel Disease Clinic Improves Quality of Care and Physician Productivity.

Electronic health records (EHRs), despite their positive attributes, increase physician workload and decrease efficiency. The aim of this study was to evaluate the impact of scribes in the Inflammatory Bowel Disease Clinic on improvement of the physician-patient relationship, physician productivity, clinical efficiency, and achievement of some Physician Quality Reporting System (PQRS) metrics. We analyzed of pre- and postscribe data between fiscal years 2015 (FY15) and 2016 (FY16) using data from patients at the Inflammatory Bowel Clinic at the University of Florida. The main outcomes were patient satisfaction scores (PSS), qualitative physician interview, clinic appointment lengths, work relative value units (wRVUs), level of coding, revenue, and PQRS data on bone density screening and vaccination. PSS increased from 6.8/10 to 9.2/10 (P < 0.01), clinic appointment length decreased by 13.5 minutes (P < 0.05), and documentation stress decreased. Clinic visits increased by 76, leading to an increase in work RVUs by 332.55, total charges billed by $71,439, and total charges collected by $27,387 between the first quarters of FY15 and FY16. The extra revenue for the first quarter was 536% higher than the salary of the scribe for the same period ($4302.84). There was a 1.8-fold increase in referrals for bone density scans and 2.9-fold and 4.8-fold increases in vaccination rates for influenza and pneumonia, respectively. The use of scribes improved the physician-patient relationship, clinical efficiency, physician productivity, bone density screening, and vaccinations for flu and pneumonia. If adopted by health systems, it may lead to significant cost savings and improved clinical outcomes.

What Is the State of Quality Measurement in Spine Surgery?

Value-based healthcare models rely on quality measures to evaluate the efficacy of healthcare delivery and to identify areas for improvement. Quality measure research in other areas of health care has generally shown that there is a limited number of available quality measures and that those that exist disproportionately focus on processes as opposed to outcomes. The purpose of this study was to assess the current state of quality measures and candidate quality measures in spine surgery. (1) How many quality measures and candidate quality measures are currently available? (2) According to Donabedian domains and National Quality Strategy (NQS) priorities, what aspects or domains of care do the present quality measures and candidate quality measures represent? We systematically reviewed the National Quality Forum, the Agency for Healthcare Research and Quality, and the Physician Quality Reporting System for quality measures relevant to spine surgery. A systematic search for candidate quality measures was also performed using MEDLINE/PubMed and Embase as well as publications from the American Academy of Orthopaedic Surgeons, Congress of Neurological Surgeons, and the North American Spine Society. Clinical practice guidelines were included as candidate quality measures if their development was in accordance with Institute of Medicine criteria for the development of clinical practice guidelines, they were based on consistent clinical evidence including at least one Level I study, and they carried the strongest possible recommendation by the developing body. Quality measures and candidate quality measures were then pooled for analysis and categorized by clinical focus, NQS priority, and Donabedian domain. Our initial search yielded a total of 3940 articles, clinical practice guidelines, and quality measures, 74 of which met criteria for inclusion in this study. Of the 74 measures studied, 29 (39%) were quality measures and 45 (61%) were candidate quality measures. Fifty of 74 (68%) were specific to the care of the spine, and 24 of 74 (32%) were related to the general care of spine patients. The majority of the spine-specific measures were process measures (45 [90%]) and focused on the NQS priority of "Effective Clinical Care" (44 [88%]). The majority of the general care measures were also process measures (14 [58%]), the highest portion of which focused on the NQS priority of "Patient Safety" (10 [42%]). Given the large number of pathologies treated by spine surgeons, the limited number of available quality measures and candidate quality measures in spine surgery is inadequate to support the transition to a value-based care model. Additionally, current measures disproportionately focus on certain aspects or domains of care, which may hinder the ability to appropriately judge an episode of care, extract usable data, and improve quality. Physicians can steward the creation of meaningful quality measures by participating in clinical practice guideline development, assisting with the creation and submission of formal quality measures, and conducting the high-quality research on which effective guidelines and quality measures depend.

Factors that Predict Failure to Meet Merit-Based Incentive Payment System Quality Measures for Asymptomatic Carotid Endarterectomy

The Physician Quality Reporting System (PQRS) created by the Centers for Medicare and Medicaid Services financially penalizes providers who fail to meet expected quality of care measures. The purpose of this study is to evaluate the factors that predict failure to meet PQRS measures for carotid endarterectomy (CEA). PQRS measure 260 (discharge by postoperative day 2 following CEA in asymptomatic patients) and 346 (rate of postoperative stroke or death following CEA in asymptomatic patients) were evaluated using hospital records from the state of Florida from 2008 to 2012. The impact of demographics, comorbidities, hospital factors, admission variables, and individual practitioner data upon timely discharge, and postoperative stroke and death. Odds ratios, 95% confidence intervals, and significance (P<0.05) were determined through the development of a logistic regression model. Surgeons were identified by national provider identifier number, and practitioner data obtained from the American Medical Association Physician Masterfile. A total of 34,235 patient records and 701 providers were identified over the 5-year period. Significant negative predictors for PQRS measure 260 included weekend admission (odds ratio [OR], 2.9), Medicaid (OR, 2.4), surgeon historical postoperative stroke rate>2.0% (OR, 1.7), African-American race (OR, 2.0), and female gender (OR, 1.3). The presence of any of these factors was associated with a 13.5% rate of failure. The most significant negative predictor for PQRS measure 346 was surgeon postoperative stroke rate >2.0% (OR, 6.2 for stroke and OR, 29.0 for death). Surgeons in this underperforming group had worse outcomes compared to their peers despite having patients with fewer risk factors for poor outcomes. Surgeon specialty, board certification, and case volume do not impact either PQRS measures. Selected groups of patients and surgeons with a disproportionately high rate of postoperative stroke are at risk of failing to meet PQRS pay for performance quality measures. Awareness of these risk factors may help mitigate and minimize the risk of adversely impacting the value stream. Further evaluation of the causative factors that lead to surgeon underperformance could help to improve the quality of care.

Society Advocacy Continues to Make Impact Amid Uncertainty

Society Advocacy Continues to Make Impact Amid Uncertainty

Quality Measures in Foot and Ankle Care

Category: Ankle, Ankle Arthritis, Arthroscopy, Bunion, Diabetes, Hindfoot, Trauma Introduction/Purpose: National healthcare delivery systems are shifting to value-based models. Understanding quality measures used to assess performance is important as they may be operationalized in alternative payment models, such as bundled payment programs, or quality reporting programs, such as the Merit-Based Incentive Payment System. Previous literature has shown that quality measures in other orthopaedic subspecialties disproportionately focus on effective clinical care or processes of care, while ignoring patient outcomes. We completed a systematic review of quality measures and candidate quality measures that address foot and ankle care to identify gaps in current measures and to inform future measure development initiatives. Methods: We conducted a systematic review of the National Quality Forum, the Agency for Healthcare Research and Quality, and the Physician Quality Reporting System for quality measures related to foot and ankle care. We also reviewed candidate quality measures from clinical practice guidelines (CPG) in the literature meeting Institute of Medicine CPG criteria. Measures were classified by clinical entity, Donabedian domain (structure, process, or outcome), and the National Quality Strategy (NQS) priority that they addressed. Results: We identified 12 quality measures and 16 candidate measures. Quality measures addressed NQS priorities of “Effective Clinical Care” (33%), “Communication and Coordination of Care” (58%), “Patient Safety” (25%), “Community and Population Health” (8%), and “Person and Caregiver Centered Experience and Outcomes” (8%). All candidate measures addressed “Effective Clinical Care”. Furthermore, 83% of quality measures and 94% of candidates were process measures, 17% of quality and 6% of candidate were outcome measures, and there were no structure measures. Diabetic foot care was the most commonly addressed clinical entity for both quality measures (58%) and candidate measures (69%). Conclusion: Foot and ankle quality measures and candidate measures disproportionately assess effective clinical care and processes of healthcare delivery. Additionally, few clinical disorders within the field are included, focusing primarily on diabetic foot care. Currently only two outcome measures exist, leaving an opportunity for outcome measure development. These patterns are reflected in candidate measures, suggesting that the narrow focus of quality measures will continue unless efforts are made to develop more comprehensive measures. Additional measures that address a broader array of clinical disorders across the spectrum of NQS priorities and Donabedian domains are needed to prepare for a quality-based healthcare system.

American Board of Family Medicine's Physician Quality Reporting System Deadline Passes with Outstanding Numbers

The American Board of Family Medicine (ABFM) is pleased to announce that >1600 clinicians submitted data to the Physician Quality Reporting System (PQRS) through the ABFM's online submission process and through the PRIME Patient Data Registry. The PQRS is a quality reporting program that encourages

Quality measurement for rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society.

Measuring quality outcomes is an important prerequisite to improve quality of care. Rhinosinusitis represents a high value target to improve quality of care because it has a high prevalence of disease, large economic burden, and large practice variation. In this study we review the current state of quality measurement for management of both acute (ARS) and chronic rhinosinusitis (CRS). The major national quality metric repositories and clearinghouses were queried. Additional searches included the American Academy of Otolaryngology-Head and Neck Surgery database, PubMed, and Google to attempt to capture any additional quality metrics. Seven quality metrics for ARS and 4 quality metrics for CRS were identified. ARS metrics focused on appropriateness of diagnosis (n = 1), antibiotic prescribing (n = 4), and radiologic imaging (n = 2). CRS quality metrics focused on appropriateness of diagnosis (n = 1), radiologic imaging (n = 1), and measurement of patient quality of life (n = 2). The Physician Quality Reporting System (PQRS) currently tracks 3 ARS quality metrics and 1 CRS quality metric. There are no outcome-based rhinosinusitis quality metrics and no metrics that assess domains of safety, patient-centeredness, and timeliness of care. The current status of quality measurement for rhinosinusitis has focused primarily on the quality domain of efficiency and process measures for ARS. More work is needed to develop, validate, and track outcome-based quality metrics along with CRS-specific metrics. Although there has been excellent work done to improve quality measurement for rhinosinusitis, there remain major gaps and challenges that need to be considered during the development of future metrics.