Frankel

A 2015 survey that assesses the quality of patient care is more comprehensive than earlier iterations, but there is still room for improvement, according to a new study from Weill Cornell Medicine. The broader survey, featuring assessments among many specialties, could provide a more thorough evaluation of the quality of health care for Americans.

The federal Centers for Medicare and Medicaid Services (CMS) last year began requiring all Medicare providers to report quality measures or incur a 1.5 percent financial penalty on reimbursements. Through the national Physician Quality Reporting System (PQRS), the CMS last year unveiled a new survey measuring patient quality, replacing a 2011 version that was optional but offered physicians incentives to complete.

In their study, published May 19 in the Journal of General Internal Medicine, the researchers compared the 2011 and 2015 surveys – including 198 and 254 individual measures, respectively – to discern which quality measures they emphasize and how the two versions differ. The analysis revealed the 2015 version used more outcome measures – how a patient does on a particular blood test to measure their diabetes control, for example – than process measures, such as whether they ran the blood test to assess diabetes. In 2015, this was particularly true for surgery. Both versions measured many medical specialties – with more than half applying to non-internal medicine, the researchers noted. They say their findings highlight the importance of assessing quality care across a wide range of specialties to identify areas of strength, weakness and growth, which ultimately could improve patient care.

“This study is important to the public health sector since measures reported through PQRS will be used to evaluate how well physicians are meeting patient care standards, which will further affect physicians’ reimbursement and practices in the future,” said lead author Brittney Frankel, a third-year medical student at Weill Cornell Medicine. “By improving upon the reporting conducted in previous years, the PQRS ultimately ensures physicians understand how to improve their practice to provide long-term quality of care for all Americans.”

The study found the 2015 survey expanded the reporting categories from the 2011 iteration to include in-demand specialties, such as surgery, pediatrics, and obstetrics and gynecology, and increased focus on chronic conditions – inflammatory bowel disease, rheumatoid arthritis and dementia among them. The investigators said these new measures establish a more effective benchmark the CMS can use to evaluate the physicians’ performance in delivering quality care.

For the 2015 measures, the researchers found most internal medicine measures were processes as opposed to outcomes, while for surgery the opposite was true. The newer survey fell short – as did its predecessor – in measuring how health care is responsive to the needs and values of its patients, as well as the efficiency of patient care and its relation to population health, the researchers noted. They emphasized future surveys need to measure more fully how well a patient’s wishes are reflected in their care.

“We hope that this study will spur interest in looking more closely at PQRS measures, and perhaps even the development of new and improved ones,” Frankel said. “The next steps would be to understand whether increasing the number and scope of measures would have important effects on physicians and patients.”

Jamie Black is an editorial intern for Weill Cornell Medicine.