PCPs and Quality: Too Much of a Measured Thing

Primary care physicians faced an average of 57 unique quality measures across more than seven contracts, an overload that undercuts value-based care, according to a research letter published today in JAMA Health Forum.

“Value-based contracting is intended to incentivize care improvement, but it is unlikely a clinician or practice can reasonably optimize against 50 or more measures at a time,” wrote Claire Boone, Ph.D., a postdoctoral fellow at the University of Chicago Booth School of Business.

Value-based contracts had an average of 10.24 quality measures, Boone and her colleagues found, and Medicare contracts had more measures, on average, than commercial or Medicaid ones (13.42 vs. 10.07 vs. 5.37).

Boone and her colleagues had contract data on just over 800 primary care physicians to conduct their study. The physicians were employed by an unnamed integrated health system, although the affiliations of the authors (including Boone’s) and the mention of the approval of the Providence Research Network Institutional Review Board strongly suggest they were employed by the Providence Health System, a nonprofit Catholic healthcare system headquartered in Renton, Washington. They looked at value-based contracts for three years: 2020, 2021 and 2022.

They measured the number of unique quality of measures per physician based on their assigned patients. Patients who interacted with the health system in some way in the previous two years were assigned to primary care physicians and liked to payer contract for quality measure purposes based on their insurance coverage at the end of the year.

The results that the number of value-based contracts per physician increased from 9.39 in 2020 to 12.26 in 2022. The average number of quality measures they faced was pulled up by a spike in 2021 to 64.08 measures, and the average number of measures was lower in 2022 (52.37) than it was in 2020 (54.78).

As mentioned, the number of quality measures per contract was higher for Medicare contracts than it was for commercial or Medicaid contracts. In 2022, for example, the average number of measures per Medicare contract was 15.04, according to Boone and her colleagues compared with 9.58 per commercial contract and 5.70 per Medicaid contract.

“Clarity and salience are crucial to changing behavior,” wrote Boone and her co-authors, “and the burden of extraneous information and processes has been increasingly associated with adverse outcomes, such as physician burnout.”

They continued, “As payers increasingly shift toward value-based contracts, additional research is needed to understand how their ubiquity affects benefits and how such contracts can be scaled sustainably for clinical care.”