The Challenges of Measuring, Improving, and Reporting Quality in Primary Care

Dr. Antonucci,

From the 3 Richards: Thank you for your kind and supportive letter. We have received several other direct emails from colleagues that read much like yours. The main gist has been, "We on the front lines of primary care completely agree with your critiques of the way QI has been inappropriately forced on us in primary care. Why doesn't anyone in leadership get this?"

We understand why the current mantra is "pay for value, not volume," but how does one define value? The Common Core Set1 of measures pushed by CMS represent almost everything wrong with assessing value in primary care, with the possible exception of measuring overuse of imaging for low back pain. Our national academy's policy on Value-Based Payment states that "Quality improvement lays the foundation for practices to meet expected outcomes and performance required by VBP." Its policy on Performance Measures Criteria states that it works closely with the National Quality Forum and National Committee on Quality Assurance to develop performance measures, which are based on "conditions."

Unfortunately, the looming threat of MIPS and MACRA support your pessimism about the near future of primary care and meaningless measurements. However we hope that with support from front-line family physicians, perhaps our contribution to the debate will be one small tug boat working hard to redirect the huge American healthcare ship currently sailing in the wrong direction.

1. Center for Medicare & Medicaid Services. Consensus Core Set: ACO and PCMH/Primary Care Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/ACO-and-PCMH-Primary-Care-Measures.pdf . Accessed March 1, 2017.
2. American Academy of Family Physicians. Value-Based Payment. http://www.aafp.org/about/policies/all/value-based-payment.html . Accessed March 20, 2017.
3. American Academy of Family Physicians. Performance Measures Criteria http://www.aafp.org/about/policies/all/performance-measures.html . Accessed March 20, 2017.

Competing interests: None declared