The rising number of available quality metrics makes it difficult to set measurement priorities and keep workloads manageable. In the Centers for Medicare & Medicaid Services' Merit-based Incentive Payment System alone there are nearly 300 metrics to choose from, and new measures are continually introduced by payers, regulators and other entities to fill gaps in quality measurement.
The number of disease-specific metrics, in particular, has skyrocketed, with medical specialty societies introducing measures relevant to specialists and subspecialists. For instance, hematologist-oncologists now have metrics specific to treating blood cancer rather than all types of cancer.
Along with disease-specific metrics, specialty societies are launching qualified clinical data registries, which allow specialists to electronically report and benchmark their performance on these metrics. The number of QCDRs approved by CMS for quality reporting grew by 61 percent between 2016 and 2017, from 69 to 113 registries, according to an Avalere Health analysis.
“The QCDRs offer a more efficient way of capturing and defining quality that matters to physicians, particularly in those specialties where measures were few and far between,” says Kristi Mitchell, senior vice president of Avalere.
Hospitals, however, will need to weigh the costs of using QCDRs against the potential benefits.
Helen Burstin, M.D., chief scientific officer at the National Quality Forum, offers four criteria that NQF uses to prioritize quality metrics that are most meaningful:
- Is the metric focused on an outcome? Outcome measures assess whether a patient recovered from an illness or went into remission, while intermediate outcome metrics focus on achieving key steps in recovery, such as controlling blood sugar.
- Can staff take concrete steps to improve performance on the metric? “To engage physicians, hand them metrics that they can drive improvement on,” says Burstin.
- Are the results meaningful to patients and caregivers? A patient-centered metric reflects what matters to patients, such as improvement in health status.
- Does the measure reflect an integrated view of care? “We need to begin moving toward measures that don't look just at what happened in a hospital or what happened in a doctor's office but instead reflect the patient’s trajectory across all those settings,” says Burstin.