Overcoming Challenges
Although measuring quality will never be without flaws, Dr. Suter and her colleagues have worked diligently to solve challenges. In the past five years, measure developers have addressed two seemingly impossible tasks: clinic demographic differences and trade-offs.
Measuring performance must account for the variable demographics of different clinics and their patients. How can a medical practice with 50 newly diagnosed RA patients be compared with a practice that has 75 RA patients with 30 years of disease activity? The answer is risk adjustment.
“Risk adjustment evens the playing field.” Dr. Suter explains. “Statistical prediction models tell us, ‘this practice has x amount of older patients who have had the disease a long time, and y number of younger patients who are recently diagnosed. [Therefore] we can expect [the practice] to have measurement results in this range.’” Adjusting for the risks associated with certain group characteristics allows for the comparison of different practices. “That’s where quality comes in,” Dr. Suter continues. “We try to correct for the things that aren’t under the control of the clinician, so what’s left over is due to the quality of the care they provide.”
Finally, developers face inevitable trade-offs in creating measures, particularly in achieving a balance between how much information is collected and how much effort is required to collect it. The more data collected through measures, the better they can be refined for practical use. Yet the more data required for measurement, the less time clinicians may have to spend giving quality care.
“Useful measures find a balance that is acceptable—that minimizes burden but maximizes information for the clinician,” Dr. Suter explains. Although there will never be a measure without any flaws, by receiving input and asking their colleagues to share insight into measures, developers refine measures annually to propel the movement for value-based care forward.
“We must understand what works for clinicians. Please let us know what works, what doesn’t. How could we make measures better? What measures do you want to see?” Dr. Suter asks. “Clinicians should engage with the ACR to help us build better measures so we can do a better job.”
Valuing Value
Measuring quality through such frameworks as the MVPs is the future of federal reporting. You can take several steps to help the system work more smoothly.
Track your performance.“Dashboards give some context. Are we better than average for the nation? Are we worse than the average? They allow a practice to improve as a whole and can help that practice understand how they are doing relative to the national average.”
