Clinical quality measures (CQMs) included in meaningful use need to focus more on metrics physicians are able to control and that affect the population as a whole, a recent focus group studypublished in the American Journal of Managed Care shows.
AJMC conducted this focus group study to determine what changes to CQMs, if any, top-performing meaningful use participants would make. Through focus groups of 23 top-performing “exemplars” in meaningful use attestation, several major themes emerged:
CQMs Should be Proven Effective and Relevant to Physicians
Physicians resoundingly agreed that clinical quality measures should only include those measures proven to be effective and that are relevant and in physicians’ control.
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For example, a majority of the physicians supported the reporting of population and public health measures. Furthermore, focus group members stated that population and public health reporting measures should apply to all eligible providers (EPs).
While participants in one focus group unanimously agreed that there should be a core group of CQMs for all providers, regardless of specialty, that focuses on important public health issues—such as measures related to tobacco abuse and obesity—participants at the other 2 focus groups maintained that while a few CQMs could be applicable to all providers, there should be flexibility with CQMs tailored for both primary care physicians and specialists.
For example, one participant stated that a dermatologist can still encourage his or her patient not to smoke. Although the dermatologist is not a primary care physician, she would benefit from encouraging her patient to make generally healthy choices.
Additionally, physicians agreed that those measures that have a direct impact on morbidity and mortality are important CQMs.
“Participants generally agreed that CQMs in the Clinical Process/Effectiveness domain should reflect highly prevalent conditions with long-term consequences and for which improved performance on the CQM could have considerable impact on morbidity and mortality, such as hypertension, hyperlipidemia, and diabetes,” the study reports.
Focus group members also said that those measures that are not entirely in physician control should be nixed. For example, the “receipt of specialist report,” measure does not necessarily measure the care coordination of the physician attesting to meaningful use.
“Although participants concurred that closing the loop with specialists is important for care management, there was debate about whose responsibility this was and that this measure could unfairly place additional burden on the primary care provider rather than the specialist who was receiving the revenue from providing the service.”
Clinical Quality Measures Should Be Outcomes-Based
Although participants agreed that it was harder to perform well under outcomes-based CQMs, it is important the CQMs use outcomes-based measures for outcomes that are consistent over time. Additionally, participants favored outcomes-based measures for population health management measures.
Clinical Quality Measures Should Foster Quality Care
Several of the participants complained of a box-checking mentality with past CQMs, stating that they focused on meeting certain standards rather than providing quality care.
“Participants consistently advocated that the focus of the CQM measure set should be on achieving improved outcomes without requiring additional work by providers,” the report explains. “Participants repeatedly stated that accurate calculation of measures should not require additional steps outside the routine work flow.”
EHRs Should Capture Patient-Generated Data for CQMs
Several at-home technologies have enabled patients to gather their own health data and report it to their physicians. Focus group participants stated that this patient-generated data should be input into EHRs for CQMs reporting in the future.
“Many participants agreed that there should be a review queue to ensure clinician recognition of patient-reported data, along with a way to differentiate patient-generated data from office-generated data in the EHR,” the report stated. “Providers also emphasized that there should be evidence that collecting this type of data improves outcomes before CQMs are developed.”
Some CQMs Should be Developed Locally
Locally-developed CQMs could take into account regional health issues, and help foster innovation amongst the health IT industry, several of the participants said. However, these locally-developedclinical quality measures should go through an extensive vetting process and should be limited to one per primary care physician.
Overall, participants stated that CQMs should be evidence-based and backed up by studies proving their effectiveness in promoting quality care.
“Participants advocated that the measure set be limited to CQMs that are evidence-based, flexible, and focused on high-priority conditions likely to have a large beneficial impact on the health of the US population. They proposed requiring a few core CQMs that focus on public health, such as tobacco cessation and obesity counseling, for all eligible professionals, regardless of specialty,” the report explained.
The participants of the study concluded saying that CQMs could help improve quality of care through adequate use of health IT and EHRs. However, it is important that these measures examine care delivery and aspects of care that are within the control of physicians.
“CQMs most likely to effectively improve quality in primary care should be limited to those that are evidence-based, focused on high-priority conditions, do not require additional documentation, and facilitate population management. Adhering to these standards deemed to be important to real-world primary care physicians could ensure that the MU Incentive Programs achieve their ultimate goal to ‘achieve significant improvements in care.’”
Date: November 13, 2015