I am concerned about the slippery slope of quality metrics that ACOs, private payors and CMS are stepping further down into. My primary concern is that decisions being made by payors on the use of quality metrics are too often resulting in unfair or unethical use of quality metrics. It is critical for community physicians to engage with these entities now to level the slope and establish a more optimal precedent for the future use of quality metrics.
Several years ago I participated in the Texas Medical Association's (TMA) launch of their Health Care Quality Council. One of Council’s primary interests has been the issues inherent to pay-for-performance programs and the use of quality metrics by payors. Some of these issues overlap onto the TMA's ad hoc Health IT Committee that I serve on as well. Physicians in Texas have reported to these committees about unfair and unethical applications of quality metrics such as failure to consider risk adjustments for severity-of-illness or for important socioeconomic factors. Many physicians are concerned that they are getting overwhelmed by requests for different sets of quality metrics from different private payors as well as from CMS. They are also frustrated by the variable, non-standardized methods by which each payor requires the physician's data to be formatted and/or submitted.
Based on my experience with these TMA committees, I have no confidence in the ability of insurance companies or ACOs to develop and use quality metrics in a fair and ethical manner without intimate involvement of working physicians from the community served by the ACOs/payors.
There are guiding principles available regarding the fair and ethical use of quality metrics from the TMA and the AMA. Physicians should actively engage with their ACOs and payors to ensure that these guiding principles are adhered to as quality metrics are developed.
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