Research published in the Annals of Family Medicine examines the costs to physician practices of participating in quality measurement and pay-for-performance programs. (AFM Study) The research examined eight primary care practices in North Carolina which were participating in one or more of four quality measurement programs, including Medicare’s Physician Quality Reporting Initiative. The study looked at both implementation and maintenance phase costs, and personnel as well as non-personnel expenses. The information gathered for the study was largely self-reported.
Costs were examined for each quality program, at the practice and per-clinician level. For PQRI, for example, implementation costs ranged from $920 to $22,200 at the practice level, or $368 to $11,100 on a per-clinician basis. Annual maintenance costs ranged from $207 to $12,200 at the practice level, or $83 to $4,329 per-clinician. For this program alone then, a practice might expect to pay as much as $30,000 to participate. The typical incentives available for participating were less, sometimes significantly less.
Much of the cost was caused by inadequate systems, lack of interoperability among systems and training time and manual work-arounds. It is particularly striking that even practices with electronic medical records often had to resort to extensive manual work to get the data into the format required by the quality program. While there is widespread belief that quality reporting will improve health outcomes, there is little research that supports that belief and such programs can disrupt workflows and can cause focus on some diseases or treatments, which may cause less focus on others. It also seems unfair to increasingly require, for all practical purposes, participation in these programs without covering the costs of participation. There is an opportunity for vendors to assist physicians in minimizing the cost of participation and there is also an opportunity for further research to maximize the value of the programs.