Call for Specialty-Specific Benchmarks for Cross-Specialty Quality Measures in the Quality Payment Program

Area of Science:

• Health Policy
• Medical Economics
• Healthcare Quality Improvement

Background:

• The Centers for Medicare & Medicaid Services (CMS) implemented the Quality Payment Program (QPP) to shift healthcare reimbursement from fee-for-service to pay-for-performance.
• Physicians can participate via Merit-based Incentive Payment System (MIPS), MIPS Value Pathways (MVPs), or Advanced Alternative Payment Models (APMs), submitting data on quality measures.
• Performance scores determine Medicare reimbursement adjustments, impacting physicians two years post-reporting.

Discussion:

• Cross-specialty quality measures may not be equitably reported due to varying practice emphases, potentially creating bias.
• For instance, family medicine physicians might excel in measures like blood pressure control due to their practice's focus.
• This disparity raises concerns about fair competition and equitable evaluation within the QPP framework.

Key Insights:

• No studies have directly compared physician specialty performance on cross-specialty QPP measures.
• Current QPP benchmarks are non-specialty-specific, potentially leading to unfair comparisons and evaluations.
• Significant performance differences across specialties could indicate areas for targeted improvement and guide future measure development.

Outlook:

• Establishing specialty-specific benchmarks for cross-specialty measures is crucial for equitable evaluation.
• This approach would foster fairer competition among physicians participating in the QPP.
• Future QPP development should consider specialty nuances to ensure balanced measure design and implementation.