Do quality metrics hurt patient care?

Primary care docs give thumbs up to healthcare IT, thumbs down to quality measures, penalties
By Bernie Monegain
08:43 AM
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Half of primary care physicians across the country view the increasing use of quality-of-care metrics and penalties for unnecessary hospitalizations as potentially troubling for patient care, according to a new survey from The Commonwealth Fund and the Kaiser Family Foundation.

The same survey shows 50 percent of physicians responding see healthcare information technology as a boon for quality care.

The physicians say the increased use of quality metrics to assess provider performance is having a negative impact on quality of care. Far fewer (22 percent)  see quality metrics as having a positive impact on quality.

Also, 52 percent say programs that impose financial penalties for unnecessary hospital admissions or readmissions are having a negative effect on quality of care, while just one in eight, or 12 percent, say such programs have a positive effect. Nurse practitioners and physician assistants view quality metrics and admissions penalties somewhat more favorably but still are more likely to see negative impacts than positive ones.

[See also: Quality measures 'making a difference' and 2,610 hospitals fined for readmissions.]

The findings are from a new brief based on the 2015 National Survey of Primary Care Providers, which captures the experiences and views of primary care physicians, nurse practitioners, and physician assistants related to recent changes in healthcare delivery and payment, including accountable care organizations, medical homes and increased use of health information technology.

"The survey results indicate that primary care providers' views of many of these new models are more negative than positive," the authors of the brief write. "There are exceptions: health information technology gets mostly positive views and medical homes receive mixed opinions with a positive tilt. With regard to HIT, our study indicates that primary care providers generally accept the promise of HIT to improve quality of care even if previous research shows they dislike the process of transitioning from paper- based records. Our survey results also may reflect clinicians' earlier exposure to certain models and tools."

Half of physicians and nearly two-thirds – 64 percent – of nurse practitioners and physician assistants see the advance of health IT having a positive impact on practices' ability to provide quality care to their patients. Fewer physicians (28 percent), nurse practitioners and physician assistants (20 percent) say health IT is having a negative impact on quality.

More primary care physicians view the spread of ACOs as having a negative (26 percent) rather than positive (14 percent) impact on quality, though the majority either sees no impact or is not sure. Three in 10 (29 percent) primary care physicians say they currently participate in an ACO. Among those who participate, views are more favorable, though still mixed (30 percent positive, 24 percent negative).

Other key findings are:

  • A third (33 percent) of primary care physicians see the increased use of medical homes as having a positive impact on quality, more than twice the proportion who see a negative impact (14 percent). An even larger share (40 percent) of nurse practitioners and physician assistants view the impact as positive. Those who participate in medical homes are more likely to take a positive view than those who don't: 43 percent of physicians and 63 percent of nurse practitioners and physician assistants practicing in medical homes have a positive view of their impact on quality of care.
  • Most (55 percent) of the nation's primary care physicians are currently receiving financial incentives based on quality or efficiency measures, an indication of the reach of ongoing efforts by public and private payers to reward providers for quality of care rather than for the amount of services delivered to patients.
  • Nearly half (47 percent) of physicians and just over a quarter (27 percent) of nurse practitioners and physician assistants say the recent trends in healthcare are leading them to consider an earlier retirement. This continues a 20-year trend of physician dissatisfaction with market trends in healthcare.