Longitudinal Reliability of Rheumatology Patient Safety Measures and Implications for CMS Case Minimums

Area of Science:

• Health Services Research
• Quality Improvement Science
• Rheumatology Informatics

Background:

• Reliable quality metrics are essential for accurate performance assessment in healthcare.
• Low reliability can stem from limited patient numbers or minimal inter-practice variation.
• The Merit-based Incentive Payment System (MIPS) may inadvertently reduce metric reliability due to self-selection bias.

Purpose of the Study:

• To evaluate the impact of voluntary MIPS participation on practice-specific metric reliability.
• To assess the influence of measure denominator counts on metric reliability.
• To determine if current case minimums for quality measures could be reduced.

Main Methods:

• Utilized data from the Rheumatology Informatics System for Effectiveness (RISE) registry.
• Calculated reliability for two safety measures (tuberculosis and hepatitis B screening) in full and MIPS-reporting practice cohorts.
• Analyzed reliability longitudinally, stratified by eligible patient counts.

Main Results:

• Both RISE and MIPS samples demonstrated acceptable median reliability (>0.85) with wide ranges.
• Practice-specific reliability remained high (≥0.80 with ≥20 patients; ≥0.70 with ≥10 patients) across measures and years.
• No significant reduction in reliability was observed due to MIPS participation.

Conclusions:

• Voluntary enrollment in MIPS did not negatively impact the reliability of patient safety measures.
• Acceptable metric reliability was found with lower patient denominator counts than currently mandated.
• Lowering case minimums could encourage wider participation in quality improvement initiatives.