Why CMS’s core quality measurements don’t actually measure quality

The Centers for Medicare and Medicaid Services set off a flurry of celebration last week when it announced that it had collaborated with the nation’s largest insurance companies to create a set of standardized quality healthcare measures. 

I hate to be the kid at the party who pops all the balloons, but while standardizing measurements for seven healthcare areas was undoubtedly a monumental task, it won’t actually help patients pick a good doctor. 

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In fact, the goal of the “Core Quality Measurement” Collaborative was not to ensure patients receive high-quality healthcare. According to co-collaborator American Health Insurance Plans, the standardized quality measurements are notable for “maintaining parsimony, and reducing the collective burden and cost.” 

When was the last time patients benefited from the parsimony of insurance companies? 

CMS has at its fingertips reliable, scientific outcomes data at the procedural level – real and irrefutable information about error rates, infection rates and other objective measures of healthcare quality that could actually help match patients to the best doctors for them.  

Unfortunately, the Core Quality Measurements largely ignore outcomes and focuses on process measures over outcomes metrics.  They include some, but the vast majority measure the number of visits, tests and labs requested by a physician data in favor of information about processes – such as how many annual physicals a doctor performs.  

Process-oriented measures comprise 80 percent of the core measurements, while only 20 percent of the measurements are derived from critical, objective data, such as readmission rates. 

This is as mind-boggling as it is unhelpful, as even some of the collaborators of the measurements agree. The CMS’s own statement about the Core Quality Measurements quotes Debra L. Ness, president of the National Partnership for Women & Families who says:

Our health care system urgently needs measurement that drives improvements in quality, supports informed consumer decision-making and ensures we’re paying for and incentivizing high-value care. What we released today is a start at achieving consensus on the best measures, but we need to continue pushing for even better ones. We need measurement that works for clinicians and helps them improve care, while also providing information that is meaningful and actionable for patients and families.

Meaningful, actionable measurements exist. It is unfortunate that CMS and the rest of the collaborative did not choose to use them. In particular, CMS should have incorporated more outcomes data and procedural level provider expertise into their quality measurements.  

Study after study has found that the more experienced the health care provider, the higher the quality of care. That is why the New York Department of Health requires that surgeons perform 10 supervised cases of laparoscopic gallbladder removals before they are allowed to perform the complex surgery on their own. With more than 600,000 gallbladder surgeries performed in this nation per year, mistakes are inevitable. New York’s focus on experience elevates quality and minimizes risk of injury or death. Shouldn’t the collaborative be doing the same? 

Again, I applaud the effort. But just as getting a driver’s license does not make you a good driver, knowing how often you perform cervical cancer screenings does not make you a good healthcare provider. If 100 physicians all report that they follow this set of standardized processes, they would all appear equal to someone who is searching for a doctor – regardless of expertise or experience.

Clearly these standards are not enough. What we need are quality measurements that incorporate performance transparency, experience and outcomes – measurements patients can use to make informed decisions about their own care. I don’t want to know which doctors conduct the recommended number of colorectal screenings, I want to know which doctors are best at detecting colorectal cancers – and which oncologists and surgeons are the best at treating those cancers. 

I’ve never been one to ruin a party. But until unbiased, quantifiable data plays a stronger role in the measurements of healthcare quality, I’ll be the guy sitting in the corner pointing out that all this hoopla is missing the point.

Norris is the co-founder and CEO of MD Insider, which uses big data to provide consumer-friendly physician search, match, and scheduling solutions.

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