Physician Performance Assessment Requires Broad Look at Quality Measures

Assessing physician quality based on a physician's performance on one or a few conditions—an approach used with many pay-for-performance programs—falls short in providing a comprehensive measure of physician practice quality, say the authors of a study in the December 2010 issue of Health Services Research(Holmboe et al.). The study evaluates an approach to obtain a composite measure of physician quality across a range of medical conditions and preventive services. The authors recommend that pay-for-performance programs consider more comprehensive approaches to assess physician quality and to reward physicians for achieving high-quality care. The Centers for Medicare and Medicaid Services' Physician Quality Reporting Initiative, for example, provides an incentive payment to physicians who adhere to only three quality measures in areas such as prevention, chronic care management, or care coordination.

To evaluate a comprehensive approach to assess physician quality, the authors sampled the medical records of 236 general internists and audited an average of 95 patients' records for each physician. The records were audited for seven chronic conditions (atrial fibrillation, coronary artery disease, diabetes, heart failure, hypertension, osteoarthritis, and postacute myocardial infarction), four acute conditions (depression, low back pain, upper respiratory infection, and urinary tract infection), and six preventive services (influenza and pneumococcal immunizations; screening for breast cancer, colon cancer, and osteoporosis; and smoking cessation counseling). In all, 46 performance measures were abstracted for each physician's practice to obtain an overall...