The healthcare community is strongly supportive of performance measures to further improve care quality, but remains wary because they want to be tracked in a “fair and transparent way by measures that provide useful information for consumers and for quality improvement,” Marybeth Farquhar, PhD, MSN, RN, and URAC’s vice president of quality, research, & measurement, told attendees of a recent webinar, “The Politics of Performance Measurement.”
The concept of publicly demonstrating performance metrics for healthcare systems enjoys strong bipartisan support, said Aaron Turner-Phifer, vice president, government relations and policy at URAC. At the same time, he added, the devil is in the details.
It’s not an easy conundrum to solve, Turner-Phifer told attendees. “It’s a challenge.” Part of the acceptance – both politically and among stakeholders -- depends on a broad understanding of readiness, he said. “It’s really hard to implement a program that applies to everyone.”
Unfortunately, different sectors of the healthcare space are in very different places when it comes to their view of performance metrics. Factors to consider include existing infrastructure capabilities, populations served, and training levels amongst physicians, Turner-Phifer pointed out. “There is so little uniformity amongst the groups,” he added. “It varies from clinician to clinical, from practice to practice.”
Marybeth Farquhar, PhD, MSN, RN, and URAC’s vice president of quality, research, & measurement, echoed Turner-Phifer’s comments. “It depends on the group, some are further along, some understand quality better.”
For example, whereas health plans have been measuring for quality for many years, pharmacies are not as far along on the learning curve, Farquhar said. URAC is working with many now to help them get to that level. “The pharmacies are working really hard at the quality aspect,” she added, noting the industry has made considerable progress over the past year. Some of those projects were recently covered by The URAC Report.
There’s another important roadblock to adoption, Farquhar said: The number of measures in question. Organizations and entities generally applaud the idea of performance harmonization and alignment of measures, “but we have a proliferation right now,” Farquhar said. Professionals are being asked to measure the same things in inconsistent ways, she said.
“It’s frustrating and difficult to try to interpret the results when you have standards that are different, but the same,” Farquhar said. As an example, “people are being asked to measure diabetes in three or four different ways.”
“We need to work on ways to reduce the number of measures,” agreed Jason Goldwater, senior director, National Quality Forum (NQF).
There are other issues to mull as industry works to advance the use of performance metrics, Goldwater said. It’s important to quantify the measurement burden at the very outset. How much time will this take? How many additional staff people will it require? Once an organization has made that assessment, Goldwater said, it must be ready to take steps to mitigate any issues. “It’s never the intent of a quality measurement program to take away time from patient care,” he said.
Goldwater also said he was encouraged by the rising usage of electronic health records (EHRs). Extracting measurement data from EHRs is much less time consuming, and arguably more accurate than methods employed in the past.
Pulling specific information from a paper chart is “incredibly time-consuming,” he said. Goldwater expressed optimism that increased usage of e-record capabilities is likely to further mitigate the burden of collection. He also advocated a move toward identifying a core set of measures that “have value, then looking for any gaps to address, as we continue the transition to eClinical Quality Measures” (eCQM).