The Affordable Care Act calls for physician-specific performance measures to be introduced in the coming years. Lessons from Florida and Colorado offer helpful suggestions.
In order to improve quality of care, quality measurements and reporting must provide comprehensive and comparable information that is meaningful to patients and other stakeholders. Such reporting is available for hospitals, but there are challenges when measuring performance at the level of the individual physician. The authors report on a pilot project in Florida and Colorado that aggregates data on quality of care for individual physicians using a standard methodology across regions and five health plans.
Twenty-two clinical process-of-care measures were selected, including breast cancer screening, HbA1c screening in diabetes, cholesterol management for cardiovascular disease, and management of several medications. To create physician-level performance reports on these measures, physicians were assigned responsibility for providing specific health care services to patients. Termed “patient attribution,” the authors used two methods of physician-patient assignment: patient health plan selection of a primary care physician and plurality of patient visits. They set a minimum number of required observations for reporting. The data was collected from five health plans by means of a distributed data model that allowed each plan to extract its own data elements and submit to an outside data hub. Individual patient information was therefore kept confidential. The data included provider identifier data, the number of patients who qualified for a specific measure, and the number of patients who qualified for a measure and were also compliant with the measure. Physician records were matched across the health plans.
Performance reports were generated for 21,823 physicians and were made available through a secure website that was not intended to be made public. Concerning patient attribution, rates were calculated as the ratio of the patients who both qualified for a measure and were attributed to a physician to the patients who qualified for a measure but were not attributed to a physician.
Aggregated over the five health plans, 91 percent of patients who qualified for breast cancer screening, 96 percent of the patients who qualified for HbA1c screening, and 99 percent of the patients who qualified for cholesterol management for cardiovascular disease were attributed to a physician. These high rates of attribution speak to strength of the data included in each individual physician’s performance report. Addressing the fact that smaller patient sample sizes limit the measurement of quality performance, the authors also noted a trade-off between making performance measures precise ( using higher thresholds for patient sample sizes) and producing reports for as many physicians as possible.
Section 10331 of the Affordable Care Act aims to achieve the publication of quality measurement information through the use of a Physician Compare website. Information reported must include assessments of patient health outcomes, risk-adjusted resource use, efficiency, patient experience, and other relevant information deemed appropriate by the Secretary. Prior to the publication of this information, there must be consensus on how it is to be accurately collected. Aside from the hurdles that are faced in the determination of what qualifies as a measure of health care quality, we must collect both accurate and standardized information from multiple sources while maintaining patient privacy. This pilot project offers a solution to several concerns. The individual plans were able to prepare and process their own data despite being captured, defined, and stored differently from plan to plan; the project decentralized the data and allowed for the production of summary information. Partnering with health plans as opposed to individual physicians or physician groups removes the burden of reporting from the individual physicians, addresses the concern of erroneous reporting by using the health plans for third-party verification, and efficiently allows multiple kinds of measures to be analyzed.
Kameron L. Matthews, MD, Esq.