Quality reporting costs doctors more than $15.4 billion a year, Health Affairs says

Nearly 75 percent say they waste time and money with measures that aren't clinically relevant.
By Mike Miliard
11:17 AM
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"On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study of MGMA member practices is that nearly three-fourths of the groups reported being measured on quality measures that are not clinically relevant," said Halee Fischer-Wright, MGMA's president and CEO, in a statement.

Medical practices spend an average of 785 hours per physician and $15.4 billion annually reporting quality measures to Medicare, Medicaid and private payers, according to a new report in Health Affairs.

The study, led by researchers from Weill Cornell Medical College and funded by the Physicians Foundation, looked at the quality reporting efforts of primary care, cardiology, orthopedic and multi-specialty practices, polling 1000 of them (250 of each type), drawn at random from the membership rolls of the Medical Group Management Association.

Their findings suggest that, while "much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report," researchers said.

[Also: Slavitt, DeSalvo: Health IT has to work better for doctors]

Practices reported spending 15.1 hours per week per physician wrangling quality measures -- 2.6 hours each week for physicians, with the rest of the work going to nurses or medical assistants. About 12 of those hours were spent logging data into medical records solely for quality reporting.

Some 80 percent of practices said they spend more time managing quality measures than three years ago. Almost half said that's become a significant burden. But just 27 percent thought those measures necessarily correlated with quality care.

Beyond the time invested, the dollars add up too. Weill Cornell researchers found that practices spent $40,069 per physician each year on quality reporting – totaling $15.4 billion annually.

"The cost to physician practices of dealing with quality measures is high and rising," researchers said.

"On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study of MGMA member practices is that nearly three-fourths of the groups reported being measured on quality measures that are not clinically relevant," said Halee Fischer-Wright, MD, MGMA's president and CEO, in a statement.

"The vast majority also stated current measures are useless for improving patient care," she added. "This study proves that the current top-down approach has failed. It serves no purpose to have over three thousand competing measures of quality across government and private initiatives."

While care quality is essential and reporting standardization is critical, "if measures don't improve patient care, it’s an exercise in futility," said Fischer-Wright. "As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country."

As HIMSS16 in Las Vegas this past week, officials from the Centers for Medicare and Medicaid Services emphasized that quality measures would continue to be a key component in CMS' reimbursement programs.

[Also: Meaningful use will still be part of MIPS reimbursement, CMS says]

Kate Goodrich, MD, director of CMS' Center for Clinical Standards and Quality, said new payment rules under the Medicare Access and CHIP Reauthorization Act, or MACRA, would reimburse physicians based on a composite performance score factoring in quality measures (30 percent), resource use (30 percent), clinical practice improvement activities (15 percent) and meaningful use of information technology (25 percent).

"Our intent is to have a single, unified program," she said, while acknowledging the need for flexibility and avoiding a one-size-fits-all approach: "We know physician practices are very different from one another."

Earlier in the week, CMS Acting Administrator Andy Slavitt said the agency has been listening more intently than ever to physician feedback, working with those on the front lines to understand their pain points.

He cited actual quotes from physicians, including one who said, "Most of what I'm doing during the day is entering data into the EHR."

While offering few policy specifics, Slavitt seemed to indicate that's a message that's resonating with CMS. Doctors are "not describing problems we don't know how to solve," he said. "Job one is to bridge the gulf between our public policy work and what's actually happening with patient care. That has to become an integral part of how we do things."

Twitter: @MikeMiliardHITN