|Most Primary-Care Physician Practices May Be Too Small To Measure Quality Adequately
Rethinking the approach to performance measurement in
ambulatory care may be necessary for Medicare if the United States is
to reverse the high and rising costs of healthcare – even as
evidence grows that quality is lagging.
Now the wisdom of P4P programs is coming under scrutiny.
Researchers are beginning to realize that individual
primary care physicians may not treat enough Medicare patients as those
in group practices to reliably measure significant differences in
common measures of quality and cost performance. The findings were
printed in the Dec. 9 issue of JAMA.
David Nyweide of CMS and other colleagues examined
whether statistically meaningful differences on measures of quality and
cost could be measured more reliably for primary care groups than for
The answer was no. "Relatively few primary care
physician practices are large enough to reliably measure [the] relative
differences in common measures of quality and cost performance among
fee-for-service Medicare patients," the study in JAMA said.
The researchers drew their conclusions by looking at the
Medicare patient loads of individual physicians in three treatment
areas – mammography, diabetes and congestive heart failure (CHF)
"None of the primary care physician practices had
sufficient caseloads to detect 10 percent relativedifferences in
preventable [CHF] hospitalization or 30-day readmission after discharge
…," the researchers said.
The percentage of primary care physician practices with
sufficient caseloads to detect 10 percent relative differences in
performance ranged from less than 10 percent of practices with fewer
than 11 primary care physicians to 100 percent of practices with more
than 50 primary care physicians.
"Novel measurement approaches appear to be needed for
the twin purposes of performance assessment and accountability," the
Address: Centers for Medicare and Medicaid Services, 7500 Security Blvd., Baltimore, MD 21244; (877) 267-2323, www.cms.gov.