Are We Wasting $15 Billion on Quality Reporting?

In a new study, the national cost of quality reporting for physician practices has been estimated. The results are not surprising: a lot of time and money is spent collecting and reporting data that practices do not find meaningful.

Funded by the physician advocacy group The Physicians Foundation researchers surveyed 1,000 practices from four specialties — internal medicine, family medicine, orthopedics, and cardiology — in the Medical Group Management Association database. Quality for hospitals and other entities was not included.

A practice representative estimated time spent on activities related to reporting quality measures to external entities, including work required for data entry, data transmission, and reviewing reports. Time spent by various staff members of the practice was extrapolated to estimate total national costs by (1) multiplying the average hours spent by (2) average national hourly compensation, including fringe benefits, then multiplied again by (3) the number of practicing US clinicians. Opportunity costs were not factored.

The results showed that of 15.1 weekly hours of practice effort, physicians spend 2.6 hours, mostly in entering information, toward quality reporting.  Despite comprising a smaller proportion of time spent, physicians make up nearly half the total costs.

Notably, physicians only spend 6 minutes per week reviewing the quality reports and only 28% of practices use their reports to focus their quality improvement (QI) activities.

However, there are methodological limitations to this study. Indirect and start-up infrastructure costs were not accounted for. Additionally, estimated costs were 5 to 10 times higher than two previous studies published in 2009 and 2012 that performed more careful time and cost estimations in primary care practices.

As a result, the study must be interpreted with caveats. First, the true value of quality reporting is not considered, as the quality of health care delivered was not quantified. Second, we shouldn’t conflate practice spending as a variable cost that could potentially be eliminated. Third, time burdens mostly fall on administrators and ancillary staff, not physicians. Fourth, in an industry that spends over $3 trillion annually, about $600 billion of which goes towards physician offices, $15 billion to study quality may not represent wasted spending. Finally, the imprecise calculations should be viewed as simple ballpark estimates.

Still, this study sheds light on the scale of effort required to navigate a chaotic world of variable reporting requirements to multiple stakeholders. Clearly, physicians are not finding the reports meaningful because they spend nearly no time reviewing them and only occasionally use it to refine QI efforts. Less demanding means of data extraction are sorely needed.

Effort spent reporting quality data crowds out other meaningful activities to improve care delivery. While measurement is a fundamental part of improvement science, a course correction is necessary to facilitate true population health improvement. The study, by quantifying the burden and potential harm of our current state, supports calls for caution against the misuse of flawed quality reporting structures.

commentary by Thomas Kim, MD

Abstract

Each year, US physicians practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion dealing with the reporting of quality measures. While much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report. PMID: 26953292

Casalino, LP, et al. Health Affairs. 2016; 35 (3): 401-406.