P4P Quality

The cost of quality measurement

An interesting editorial in JAMA by Schuster, Onorato and Meltzer (2017) makes the following point:

So how should quality measures be prioritized? Many factors are currently considered, including a measure’s expected effect on patients and health care, potential for promoting improvement, scientific underpinnings, usability, and feasibility. But there is a major omission from this list: the cost of each measure. The cost of specific measures has received limited attention in discussions about global costs of quality measurement and is not formally considered when evaluating and selecting measures, in no small part because that cost is usually unknown. Without understanding the cost of a specific measure, assessing its value cannot be fully determined.

The development of quality measures I believe should be independent of costs.  The reason is that the cost of implementation is likely very heterogeneous.  For a single practice physician to start collecting a wider range of MIPS quality measures is likely very onerous; to implement these same measures as part of a large, regional integrated delivery network is likely much lower (likely not in total but on on a per patient basis or as a share of total cost).  Thus having quality measures available and certified is likely useful to some but not all physician practices.

The point is that the implementation of quality measures or the formation of mandatory quality metric sets should clearly be based on not only the importance of the measure, but also the cost of data collection (among other factors).


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