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A Cross-Sectional Assessment of the Quality of Physician Quality Reporting System Measures
Brittney A Frankel1, Tara F Bishop2,3,4
1Weill Cornell Medicine, 402 E. 67th St., Room LA-215, New York, NY, 10021, USA. baf2011@med.cornell.edu.
Background:
Starting in 2015, the Center for Medicare and Medicaid Services (CMS) requires all Medicare providers to report quality measures through Physician Quality Reporting System (PQRS) or incur a 1.5 % financial penalty. Research indicates that physicians believe this reporting does not lead to high quality care; however, little research has examined what PQRS actually measures, which is reflective of the physicians and patient disease populations being assessed.
Objectives:
(1) Identify the proportion of measures that apply to different medical specialties, types of quality measurement, and National Quality Strategy (NQS) priorities. (2) Identify how different specialties are required to measure quality and NQS priorities. (3) Compare the 2011 and 2015 measures.
Design And Main Measures:
This was a categorical qualitative analysis of 2011 and 2015 PQRS measures. One hundred and ninety-eight and 254 individual measures, respectively, were analyzed by three domains: medical specialty measured, type of measure, and NQS priority category.
Key Results:
Between 2011 and 2015, the type of measures changed significantly, with fewer processes (85.4 % vs. 66.5 %, p < 0.001) and more outcomes (12.6 % vs. 29.1 %, p < 0.001). The measures showed no significant specialty or NQS category differences. For subcategories within each specialty in 2015, differences in measure type were statistically significant: surgery had the highest percentage of outcomes (61.1 %) compared to 21.7 % of internal medicine and 5.9 % of obstetrics/gynecology. For NQS categories, internal medicine had the highest percentage of effective clinical care measures (68.5 %), compared to 22.2 % in surgery. Surgery had the highest percentage of patient safety (31.9 %) and communication and care coordination measures (27.8 %) compared with internal medicine (5.4 % and 6.5 %).
Conclusions:
Our study shows that PQRS measures include many medical specialties and significantly more outcomes in recent years, particularly for surgery. PQRS still lacks sufficient measures for half of NQS priorities and sufficient outcomes to assess internal medicine and obstetrics/gynecology. CMS must continue to improve PQRS measures to better assess and encourage high-quality care for all Americans.
Insights
Physician Quality Reporting System (PQRS) measures increasingly focus on outcomes, especially in surgery. However, PQRS needs improvement to adequately assess quality across all medical specialties and National Quality Strategy priorities.
Area of Science:
- Health Services Research
- Medical Quality Assurance
- Healthcare Policy
Background:
- The Center for Medicare and Medicaid Services (CMS) mandates Physician Quality Reporting System (PQRS) participation for Medicare providers, with financial penalties for non-compliance.
- Physician perception suggests PQRS reporting does not inherently enhance care quality.
- Limited research exists on the specific content and applicability of PQRS measures across diverse medical specialties and patient populations.
Purpose of the Study:
- To analyze the proportion of PQRS measures relevant to different medical specialties, quality measurement types, and National Quality Strategy (NQS) priorities.
- To examine how quality measurement and NQS priorities differ across medical specialties.
- To compare PQRS measures from 2011 and 2015.
Main Methods:
- A categorical qualitative analysis of 2011 and 2015 PQRS individual measures.
- Measures were analyzed across three domains: medical specialty, type of quality measure, and NQS priority category.
- Statistical analysis was performed to identify significant differences and trends.
Main Results:
- Between 2011 and 2015, a significant shift occurred from process measures to outcome measures (85.4% to 66.5% vs. 12.6% to 29.1%).
- No significant differences in specialty or NQS category distribution were observed overall.
- In 2015, surgery specialties showed a higher proportion of outcome measures (61.1%) compared to internal medicine (21.7%) and obstetrics/gynecology (5.9%).
- Internal medicine had the highest proportion of effective clinical care measures (68.5%), while surgery led in patient safety (31.9%) and care coordination (27.8%) measures.
Conclusions:
- PQRS measures encompass a wide range of medical specialties and have increased outcome-based reporting, particularly for surgery.
- PQRS currently lacks sufficient measures for half of the NQS priorities and adequate outcome measures for internal medicine and obstetrics/gynecology.
- Continued refinement of PQRS measures by CMS is essential to effectively assess and promote high-quality care nationwide.
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