CMS should pause the Merit-Based Incentive Payment System (MIPS) to reassess and improve quality measures used to determine payment adjustments, ACP advised.

April 23, 2018 - The American College of Physicians (ACP) is calling for a “time-out” to assess and improve Merit-Based Incentive Payment System (MIPS) quality measures after finding few of the measures used to determine clinician performance and payment adjustments in the program were valid.

According to ACP’s criteria, only 37 percent of the 271 quality measures used in MIPS are valid, the analysis in the New England Journal of Medicine showed. These quality measures met validity in five domains: importance, appropriateness, clinical evidence, specifications, and feasibility and application.

However, 35 percent of MIPS quality measures did not pass ACP’s five-pronged validity test, and 28 percent were of uncertain validity.

“The fact that only 37 percent of measures proposed for a national value-based purchasing program were found to be valid with a standardized method has implications for physician-level performance measurement,” the report stated. “The use of flawed measures is not only frustrating to physicians but also potentially harmful to patients. Moreover, such activities introduce inefficiencies and administrative costs into a health system widely regarded as too expensive.”

Physicians already feel skeptical about quality measures and performance evaluations. A 2016 survey showed that almost two-thirds of physicians (63 percent) think current measures do not actually capture the quality of care they deliver.

Yet, physician practices spent more than $15.4 billion a year, or $40,000 per physician, to report quality measures, the same survey showed. Performance reporting also took up 785 hours per physician to complete.

The most recent ACP analysis may have given physician concerns some ground on which to stand. Of the 30 MIPS quality measures deemed not valid according to the ACP’s criteria, researchers found 19 measures did not have sufficient evidence to support them.

For example, MIPS measure 181, “Elder Maltreatment Screen and Follow-Up,” requires eligible clinicians reporting this measure to complete the Maltreatment Screening tool on the date of an encounter and a documented follow-up plan for all patients 65 years or older.

However, the US Preventative Services Task Force has found insufficient evidence that routine screening for elder abuse is necessary.

“We believe the substantial resources required to screen large populations of elderly patients for maltreatment and to track follow-up would be better directed at care processes whose link to improved health is supported by more robust evidence,” the report stated.

Inadequately specified exclusions was another major issue with the MIPS quality measures that were deemed not valid. These MIPS quality measures required eligible clinicians to complete a process or achieve an outcome across a broad group of patients, even those who might not benefit from the care.

MIPS measure 236, “Controlling High Blood Pressure,” fell into this category. The quality measure requires that all patients in the clinic setting achieve a blood pressure of 140/90 mm Hg or lower.

But requiring that blood pressure level for frail elderly patients or individuals with certain coexisting conditions could put those patients at risk for adverse events, researchers explained.

Additionally, invalid MIPS quality measures suffered from poor specifications that might misidentify high-quality care as low-quality care. For example, MIPS measure 009, “Anti-Depressant Medication Management,” requires patients who start an antidepressant medication to continue taking the drug three and six months after initiation.

However, the measure does not account for patient preferences, researchers contended. Patients may choose to engage in alternative evidence-based treatment, such as psychotherapy or electroconvulsive therapy, after experiencing side effects of antidepressant medications.

The volume of MIPS quality measures found not valid coupled with the issues with the invalid measures indicates that CMS should pause the program while the industry reassesses the program’s methodology for evaluating physician performance and determining payment adjustments.

The issues also point to a larger issue with quality measurement in the healthcare industry, ACP added.

“If developers, assessors, and public and private payers adopted a more rigorous method of assessing measures’ validity, potential problems could be identified before the measures were launched,” the report stated. “It makes sense for practicing clinicians to participate in the development and review of measures. At the same time, a single set of standards (like those put forth by the National Academy of Medicine for clinical practice guidelines) could be developed that would allow others to evaluate the trustworthiness of performance measures.”

CMS and other leaders should also stop relying on the use of “easy-to-obtain data,” such as administrative data to influence quality measure development. The federal agency has taken several steps to ensure MIPS quality reporting is less burdensome than legacy value-based purchasing programs. Use of claims data, various reporting mechanisms, and a web-based reporting system are among the efforts taken to reduce administrative burden.

But ACP argued that some of these efforts may be harming physician performance measurement, rather than helping to reward high-quality care.

“Instead, it [performance measurement] should be fully integrated into care delivery, where it would effectively and efficiently address the most pressing performance gaps and direct quality improvement,” the group concluded. “For now, we need a time-out during which to assess and revise our approach to physician performance measurement.”

  

By: Jacqueline Belliveau

Source: https://revcycleintelligence.com/