Factors that Predict Failure to Meet Merit-Based Incentive Payment System Quality Measures for Asymptomatic Carotid
Anahita Dua1, Steven Koprowski2, Fadwa Ali3
1Division of Vascular Surgery, Stanford Hospital and Clinics, Palo Alto, CA.
Insights
Certain patient and surgeon factors increase the risk of failing Physician Quality Reporting System (PQRS) measures for carotid endarterectomy (CEA). Identifying these risks can improve quality of care and financial performance.
Area of Science:
- Vascular Surgery
- Health Services Research
- Quality Improvement
Background:
- The Physician Quality Reporting System (PQRS) imposes financial penalties on healthcare providers for not meeting quality of care standards.
- Carotid endarterectomy (CEA) is a common surgical procedure with established quality metrics.
- Understanding factors that predict failure to meet PQRS measures for CEA is crucial for maintaining provider reimbursement and ensuring quality care.
Purpose of the Study:
- To identify demographic, clinical, and provider-specific factors that predict failure to meet PQRS measures 260 and 346 for carotid endarterectomy (CEA).
- To analyze the impact of these factors on timely discharge and postoperative stroke or death rates following CEA.
Main Methods:
- Retrospective analysis of hospital records from Florida (2008-2012) for 34,235 CEA procedures.
- Logistic regression modeling was used to determine odds ratios and significance (P < 0.05) for various predictors.
- Surgeon data was obtained from the American Medical Association Physician Masterfile.
Main Results:
- Weekend admission, Medicaid insurance, African-American race, and female gender were associated with delayed discharge (PQRS measure 260).
- Surgeons with a historical postoperative stroke rate >2.0% were significant predictors of failure for both timely discharge and adverse outcomes (PQRS measure 346).
- Surgeon specialty, board certification, and case volume did not impact PQRS measure performance.
Conclusions:
- Specific patient populations and underperforming surgeons face a higher risk of failing to meet PQRS quality measures for CEA.
- Awareness of these risk factors is essential for mitigating negative impacts on value-based care.
- Further investigation into the causes of surgeon underperformance is recommended to enhance the quality of CEA care.
Background:
The Physician Quality Reporting System (PQRS) created by the Centers for Medicare and Medicaid Services financially penalizes providers who fail to meet expected quality of care measures. The purpose of this study is to evaluate the factors that predict failure to meet PQRS measures for carotid endarterectomy (CEA).
Methods:
PQRS measure 260 (discharge by postoperative day 2 following CEA in asymptomatic patients) and 346 (rate of postoperative stroke or death following CEA in asymptomatic patients) were evaluated using hospital records from the state of Florida from 2008 to 2012. The impact of demographics, comorbidities, hospital factors, admission variables, and individual practitioner data upon timely discharge, and postoperative stroke and death. Odds ratios, 95% confidence intervals, and significance (P < 0.05) were determined through the development of a logistic regression model. Surgeons were identified by national provider identifier number, and practitioner data obtained from the American Medical Association Physician Masterfile.
Results:
A total of 34,235 patient records and 701 providers were identified over the 5-year period. Significant negative predictors for PQRS measure 260 included weekend admission (odds ratio [OR], 2.9), Medicaid (OR, 2.4), surgeon historical postoperative stroke rate >2.0% (OR, 1.7), African-American race (OR, 2.0), and female gender (OR, 1.3). The presence of any of these factors was associated with a 13.5% rate of failure. The most significant negative predictor for PQRS measure 346 was surgeon postoperative stroke rate >2.0% (OR, 6.2 for stroke and OR, 29.0 for death). Surgeons in this underperforming group had worse outcomes compared to their peers despite having patients with fewer risk factors for poor outcomes. Surgeon specialty, board certification, and case volume do not impact either PQRS measures.
Conclusions:
Selected groups of patients and surgeons with a disproportionately high rate of postoperative stroke are at risk of failing to meet PQRS pay for performance quality measures. Awareness of these risk factors may help mitigate and minimize the risk of adversely impacting the value stream. Further evaluation of the causative factors that lead to surgeon underperformance could help to improve the quality of care.
