The Evolution of Measurement
Lately, I have been hearing complaints from physicians about some of the clinical care measures being used in the state’s quality measurement and reporting initiative that is scheduled to begin in January. They tell me that although the measures may be well-intended, some of them put too much pressure on physicians and hold them responsible for their patients’ behavior—something that physicians cannot easily manage or control. They also say it’s unfair to compare physicians without adjusting for the severity of their cases or other important factors.
Hearing these concerns made me think this was an opportunity to talk about the evolution of some of these measurement efforts—where they came from, where they are headed, and why they are important.
Monitoring quality is not new to physicians in Minnesota. They have been doing their own quality measurement and reporting within hospitals and clinics for years through activities such as morbidity and mortality conferences, peer review, research, internal monitoring efforts, and more formal quality-improvement efforts.
External forces have shaped more recent quality-measurement efforts, with health plans, government, and employers exerting increasing influence. In 2000, three Minnesota health plan medical directors embarked on an effort to measure medical group performance. After a year of discussion with colleagues, they agreed to develop a project that would evaluate the extent to which physicians provided optimal care to their diabetic patients. In 2003, data from the project were released to the participating medical groups. Information about how medical groups scored on that measure and seven others was presented to the public for the first time in 2004. The following year, the initiative was officially incorporated as MN Community Measurement, with the MMA as a founding member.
In 2005, MN Community Measurement released its second report to the public. This one included comparisons between medical groups. By 2006, 13 clinical measurements from more than 700 medical clinics in Minnesota and the surrounding states were being reported.
The development of more and more data about the quality of medical care—driven by efforts to improve quality and provide patients with information to inform their decision making—captured the attention of both state and federal lawmakers. The federal 2006 Tax Relief and Health Care Act led to the establishment of the Centers for Medicare and Medicaid Services’ Physician Quality Reporting System (PQRS), a voluntary program in which physicians collected and reported their practice data relative to a set of performance measures. Congress has since made the PQRS permanent.
Last year, the Minnesota Legislature passed the Health Care Reform Act, which requires the expansion of quality reporting to all clinics and hospitals in the state. In 2010, physician reporting begins for optimal diabetes care, vascular care, and use of health information technology. The Minnesota Department of Health will use this information to issue annual reports to the public about the quality of services offered by provider groups.
Although quality reporting offers physicians an opportunity to improve care, the interests of the various stakeholders in both the voluntary and mandated programs may not always be aligned. For example, physicians may be more sensitive to the validity and reliability of the data than patients or payers. In addition, measure selection for cost-containment purposes, without clear evidence of a clinical benefit, will raise the ire of physicians. To this end, the MMA will work to ensure that quality measurement and reporting is done with the best interests of both physicians and patients in mind. By doing so, we will be able to not only reduce costs where appropriate but also make sure our patients receive the highest-quality care.