All Quality Metrics are Wrong; Some Quality Metrics Could Become Useful

PLAIN-LANGUAGE SUMMARY

Editorial 

 All Quality Metrics Are Wrong; Some Quality Metrics Could Become Useful

Background: This editorial builds on a study by Brulin and Teoh, released ahead of the March/April 2025 issue of Annals of Family Medicine, which found that performance-based reimbursement is associated with lower perceived quality of care by increasing illegitimate tasks and moral distress for primary care physicians. Despite past evaluations showing mediocre results, pay-for-performance quality metrics have proliferated, supported by multiple levels of government.

Editorial Stance: Quality metrics and pay-for-performance initiatives are far more expensive than many patients, clinicians, or administrators realize, prompting a reevaluation of the pay-for-quality approach in primary care. The authors call for more rigorous review—through cluster randomized controlled trials—both before and after implementation, and for prompt de-implementation of metrics with little impact or that detract from care. They recommend refocusing incentives on targets that are impactful, time limited, low cost, and physician controlled. Otherwise, pay-for-performance risks continuing to add administrative burdens and unrecognized costs that further degrade the value of primary care.

Why It Matters: The article’s title—“All Quality Metrics Are Wrong; Some Quality Metrics Could Become Useful”—highlights that while no single metric is perfect, some can support better care if applied thoughtfully and tested in real-world settings. Overall, the authors advocate aligning pay-for-performance with realistic clinician workflows and meaningful outcomes, rather than relying on a one-size-fits-all model that can distort clinical priorities and patient care.

All Quality Metrics Are Wrong; Some Quality Metrics Could Become Useful

Michael E. Johansen, MD, MS, et al 

Grant Family Medicine, OhioHealth, Columbus, Ohio