Because it sounds so obviously logical, policymakers and payers have been quick to adopt and enforce various pay-for-performance and quality reporting schemes, often ignoring warnings about design and operational issues. A report from the Urban Institute details concerns about such programs and offers suggestions for a path to improving them. (Urban Inst. Report) The goal of quality reporting and incentive programs is quality improvement, yet the evaluations of most of these programs show very little if any progress on that goal to date. This may be because the programs tend to focus on process measures which may have little to do with real health outcomes, but are easier to collect data on. One big problem with these programs is that they are disruptive and expensive to comply with, and they may hinder a clinician’s sense of autonomy and motivation. The authors detail the problems and concerns and then give seven well-thought out recommendations for improving quality reporting, pay-for-performance and value-based purchasing programs: move from measuring process to directly measuring outcomes; don’t rely solely on these programs for quality improvement but use them only where other approaches may not work; measure quality at an organizational level, not that of the individual clinician; measure patient experience and patient-reported outcomes as their own ends; promote rapid-learning through the programs; develop the science of measurement better, especially to avoid unintended consequences; and have only one entity developing measures and standards.
