qotd: Burden of reporting quality measures

Health Affairs
March 2016
US Physician Practices Spend More Than $15.4 Billion Annually To Report
Quality Measures
By Lawrence P. Casalino, David Gans, Rachel Weber, Meagan Cea, Amber
Tuchovsky, Tara F. Bishop, Yesenia Miranda, Brittany A. Frankel,
Kristina B. Ziehler, Meghan M. Wong and Todd B. Evensong

Abstract

Each year US physician 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.

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The number of quality measures directed at US health care providers by
external entities such as Medicare, Medicaid, and private health
insurance plans has increased rapidly during the past decade. These
measures, such as rates of mammography screening for women or of testing
for cholesterol or hemoglobin A1c levels for diabetes, are used to
provide publicly reported information for patients and as a basis for
financial "pay-for-performance" incentives to physicians. At least 159
measures of outpatient physician care are now publicly available. The
movement toward accountable care organizations, the federal Sustainable
Growth Rate "fix" legislation, and the private-sector Catalyst for
Payment Reform coalition will further emphasize measurement of physician
performance.

Anecdotally, dealing with these measures imposes a considerable burden
on physician practices in terms of understanding the measures, providing
performance data, and understanding performance reports from payers, but
the extent of that burden has not been quantified. We present results
from a national survey of practices representing three common physician
specialty and multispecialty practices.

From the Study Results

On average, physicians and staff spent a total of 15.1 hours per
physician per week dealing with quality measures, with the average
physician spending 2.6 hours per week and other staff spending 12.5 hours.

By far the most time — 12.5 hours of physician and staff time per
physician per week — was spent on "entering information into the medical
record ONLY for the purpose of reporting for quality measures from
external entities."

The time spent by physicians and staff translates to an average cost to
a practice of $40,069 per physician per year.

From the Discussion

There is much to gain from quality measurement, but the current system
is far from being efficient and contributes to negative physician
attitudes toward quality measures. Improving the system rapidly will be
difficult. Obstacles include the fragmented US health care system, lack
of interoperability across EHRs, lack of EHR functionalities to
facilitate retrieval of data for quality measures, the cost of change to
external entities and to providers, and opposition from vested
interests. Increasing efforts to reduce the number of measures and to
standardize their use across external entities are being made by the
National Quality Forum, the Institute of Medicine, and America's Health
Insurance Plans, as well as by federal agencies such as the Centers for
Medicare and Medicaid Services and the Agency for Healthcare Research
and Quality. Our data suggest that US health care leaders should make
these efforts a priority.

http://content.healthaffairs.org/content/35/3/401.abstract

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Comment by Don McCanne

Quality measures in health care have proven to be burdensome, consuming
excess resources in both time and money. This study quantifies those costs.

Not only do these quality games waste resources, they have become a
significant contributor to physician burnout.

Wouldn't it be far better to devote these extra resources to improving
access to actual health care for the uninsured and underinsured who are
now being all too often left out? It would be automatic under a single
payer Medicare for all program.