One of the concerns constantly raised about the flood of provider quality measurement, reporting and incentive and penalty programs is the impact on physician and other clinician time and practice expense. Research in Health Affairs suggests that these programs are causing significant costs to physician practices. (HA Article) The study was based on data collection for 2014-2015 from cardiology, orthopedic, family medicine and general internal medicine practices and multi-specialty practices that included primary care. The researchers asked about physician and staff time spend per week on tracking quality measure specifications, developing and implementing data collection processes, entering data into the medical record and collecting and transmitting data. The average physician spent 2.6 hours per week on these activities and office staff spent another 12.5 hours per physician per week on them. The biggest bucket of time by far was entering of data into records solely for quality measure reporting practice. A doctor could probably see another 9 patients using the same amount of time spent on quality measure work, and primary care doctors spent much more time on the measures than did the other specialties, so limiting the burden on them could help address the supposed looming primary care shortage. This adds up to 785.2 hours per doctor per year on these quality measure activities, or $40,069 per physician or $15.4 billion annually in cost just for these practice types. Most of the practices reported that they are spending more time on these activities than they did three years ago, partly because they are responding to multiple payers and agencies, who often use different measures and specifications and even standards for performance. But only 27% of participating practices say they believe the measures actually reflect meaningful aspects of quality of care and only 28% use the data they are forced to collect for their internal quality improvement activities.
It is pretty clear that, however well-intentioned, our current approach to quality measurement and reporting is seriously flawed. It has little value to patients, it may have little to do with real outcome improvement, it imposes substantial costs on the system, it frustrates and lessens job satisfaction for clinicians, and it may push practices to spend time on matters that have little value while ignoring those that could be more important in improving quality. Notwithstanding the deluge of complaints and research indicating the flaws, payers and regulators just blithely push ahead, completely ignoring providers’ concerns. Not likely to end well.