Performance Metrics Must Drive Quality, Value

The effort to drive quality-based performance in physicians is now evident in the provision of preventive medicine. Some doctors rely on prescribing drugs as a way to treat conditions, such as high blood pressure or diabetes, often ignoring more cost-effective options since they are usually rewarded for meeting quality targets regardless of how the targets were met.

Researchers at Dartmouth University including Dr Nancy Morden, an associate professor for Health Policy and Clinical Practice, and Professors Dr Elliot Fisher, Dr Lisa Schwartz, and Dr Steven Woloshin, say that current models of quality measurement do not incentivize physicians to use the most effective therapies or treatment options. The authors stress that there must be measures that will drive accountable care, and be grounded by the best evidence-based decisions.

“Physicians spend a lot of time treating numbers—blood pressure, cholesterol levels, and glycated hemoglobin levels. Professional guidelines, pharmaceutical marketing, and public health campaigns teach physicians and patients that better numbers mean success,” wrote the authors. “Unfortunately, better numbers don't reliably translate into what really matters: patients who feel better and live longer.”

For instance, instead of jumping right to prescribing the most costly drugs for patients diagnosed with hypertension, doctors could instead be measured in relation to how they incorporate diet or exercise into their treatment plans. This “accountable prescribing” will drive performance metrics that incentivize doctors based on more cost-effective measures.

As retail sales of drugs to treat high blood pressure, diabetes, and other conditions are projected to cost $283.7 billion in 2013—and spending on prescriptions to soar 8.8% in 2014 with insurance expansion—accountable prescribing will help drive value care based off quality, rather than poorly measured targets.

Dr Morden stated that evolving quality measures is a necessary challenge for doctors to face, so that payment can be more closely linked to effective performance. “Efficient, meaningful quality measures are hard to develop, and this is just a start,” she said.

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