What Do Physicians Really Think of Quality Metrics, and What's Needed to Drive Better Performance?

It’s no secret that physicians are spread thin trying to deliver care. In addition to the traditional role of caring for their patients, there has more recently been the addition of measuring quality outcomes.

And, there’s question as to whether these metrics actually translate into what’s actually driving quality care, explained Loren Meyer, MD, president of HCA Physician Services, during a session at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum being held October 10-11 in Las Vegas, Nevada.

For example, said Meyer, the Healthcare Effectiveness Data and Information Set, which is implemented by the National Committee for Quality Assurance, is a tool used by more than 90% of insurers to measure performance. The set, which includes 81 measures across 5 domains of care, are meant to compare health plan performances but are now being used to compare practices, and many of these measures may not be applicable, according to Meyer.

“We know at the macro level that we have a lot of opportunity, but for me the question comes back down to what’s going on at the local level?” said Meyer, explaining that it’s essential to know how providers are responding and adapting to these quality measures.

In order to find out just that, HCA Physician Services constructed a survey through Survey Monkey in June that surveyed employed physicians across markets in 7 states—Colorado, Florida, Kansas, Louisiana, Montana, Minnesota, and New Hampshire.

There were 132 responses—a 24% response rate—consisting of primary care providers, medical subspecialists, and surgical specialists. Of the responses, the majority came from primary care providers, followed by surgical specialists and then medical specialists. The majority of respondents had been in practice for more than 20 years.

The survey revealed that physicians are pretty interested in achieving high-level performance on clinical quality metrics. On a scale of 1-10, there was an interest level of 7. Digging deeper, the survey asked respondents to rank 4 drivers of interest from the most influential to least influential. Driving high quality care was the main catalyst, the researchers found.

“They believe in metrics, they understand the relationship between what’s being measured to and the care of their patient population,” said Meyer, reflecting on the results.

Meanwhile, the other 3 drivers—desire to excel on metrics associated with my practice, reducing national healthcare expenditures, and personal financial incentives—had mixed rankings.

Interestingly, nearly 60% of respondents said that staffing was not a barrier to achieving high-level performance. But when asked what roles they would need additional staff to fill, the majority identified a need for staff to support documentation and coding as the most important, followed bythe category of "other", outreach to patients to help close care gaps, and to identify care gaps.

Another notable finding from the survey was that just over half of respondents said that less than 25% of their compensation would need to be affected to increase their motivation for achieving high-level performance. Meanwhile, just over 30% said 25% to 50% of their compensation would need to be impacted. Less than 10% indicated than more than 75% of their compensation would need to be impacted.

There was no majority vote on how much of the patient population would need to be in value-based reimbursement programs for an increased motivation; just over 40% said 26% to 50% would need to be involved, approximately 28% said that less than 25% would need to be involved, approximately 22% said 51% to 75% would need to be involved, and 10% said that more than 75% of patients would need to be involved.

There was one comment that Meyer highlighted, which read, “I don't think metrics always capture meaningful data on patient outcomes. Everyone games the system to do better, so not sure any data captures true information either. [W]e all want to do better and would welcome a real analysis of how we are doing with feedback of how to improve.”

The question is now what are we going to do about it, asked Meyer. From a provider perspective there needs to be:

• Better aligned incentives as incentives for provider organizations continue to mature
• Adjusted staffing models based on recognition that there may be a need to different types of staff and different roles for staff than there are now
• Optimized electronic health records to make it easier for physicians to take care of the patients in front of them
• Maintained consistent messages and reporting that go back to physicians on how they are performing

There are also opportunities for improvement amongst payer organizations, including:

• Better aligned incentives and making sure risk-sharing programs are working
• Reporting timely enough that the information is actionable
• Better attribution
• Inter-plan consistency of metrics used

“What really comes together for this is we need to figure out, even with predominantly fee-for-service world, how are payer and provider organizations, operationally and clinically, going to work together to support physicians?” said Meyer.

If we don’t make it easier for them to do the right thing, we’ll continue to struggle, he added.