Quality Metrics: Let’s Decide the Best Way “To Skin the Cat”

This old saying from Yankee culture, circa 1856, describes the dilemma facing health care providers in our modern world as they search for consistent quality metrics.

What are the right quality metrics?

How many ways can we measure quality? In this brave new world of health care, measuring cost and quality are hot topics–and for good reason.  Healthcare costs continue to rise much faster than general inflation; to the point where we now spend close to 20% of our GNP on health-related expenses. On the other hand, our multiple different methods for measuring quality are often out of synchronization with our goal of the Triple Aim–better care, lower cost, and higher patient satisfaction.

Healthcare providers are flooded with a mixture of different quality measures from different payers that distract providers from delivering uniformly good care. As our system moves to value-based care, the wide range of different measures from different payers creates a challenging burden for providers. Payers predictably use quality metrics that meet their unique needs for reporting; however, this leaves the provider trying to care for patients under a single standard but being measured against another.

The variety of data-sets payers use include the Physician Quality Reporting System (PQRS), Healthcare Effectiveness Data and Information Set (HEDIS), Group Practice Reporting Option, (GPRO), CMS EMR Incentive Programs (Meaningful Use), and the Hospital Inpatient and Outpatient Quality Reporting (HIPQR and HOPQR), along with other unique or specialized reporting measures from commercial or government-driven plans including MACRA and MIPS.

Although there is some crossover between reporting requirements, there are no uniform quality metrics across all plans and payers.

There is some hope that the payers will at least “catch the cat” with the Core Quality Measures Collaborative, which includes public and private organizations such as Medicare, medical societies, large health plans, and ERISA-based employers, along with select consumer groups. The collaborative group was formed in 2014 to produce some agreement on quality measures for the most common medical conditions. This group was able to define a standard quality metrics list for primary care, six specialty types, and ACOs.

Obviously this cat has nine lives because we are now three years out and still struggling with multiple quality metrics.

The market may drag the quality metrics consolidation along as the demand for value-based payments (VBP) moves forward. Physicians practice the same way with all patients so working with a single standard of quality simply makes sense.

So what can you do, you might rightfully ask?

Give the best care; it is the best task

It’s quality that we really want to measure

and good outcomes that we actually treasure.

What is the best way to “skin this crazy cat?”

“The Cat in the Hat knows a lot about that!”

Craigan Gray

About the Author

Craigan Gray, MD, MBA, JD

Dr. Craigan Gray, Salient Healthcare’s Chief Medical Officer, brings rich experience from private practice, hospital leadership, and governmental health-benefit programs. Prior to joining Salient, Dr. Gray was director of North Carolina’s $12 billion Medicaid program. His time as VPMA at Bon Secours Our Lady of Bellefonte Hospital in Kentucky was distinguished by moving the facility into the top-quality performance tier for Health Grades and CMS health quality indicators. Dr. Gray is a Stanford University trained Obstetrician/Gynecologist. In addition to an MD degree, Dr. Gray holds an MBA degree and a JD degree. He is a Certified Physician Executive and is published in various medical journals.

Leave a Reply

Your email address will not be published. Required fields are marked *