Primary Care Physicians' Conceptualization of Quality in Medicare's Merit-Based Incentive Payment System

被引:1
作者
Berdahl, Carl T. [1 ,2 ,3 ]
Easterlin, Molly C. [3 ,4 ,5 ,6 ]
Ryan, Gery [7 ]
Needleman, Jack [8 ]
Nuckols, Teryl K. [1 ]
机构
[1] Cedars Sinai Med Ctr, Dept Med, 8700 Beverly Blvd,Becker 113, Los Angeles, CA 90048 USA
[2] Cedars Sinai Med Ctr, Dept Emergency Med, West Hollywood, CA USA
[3] Univ Calif Los Angeles, Natl Clinician Scholars Program, Los Angeles, CA USA
[4] Cedars Sinai Med Ctr, Dept Pediat, Los Angeles, CA 90048 USA
[5] Los Angeles Cty, Dept Pediat, Div Neonatal Med, Los Angeles, CA USA
[6] Univ Southern Calif, Los Angeles, CA 90007 USA
[7] Kaiser Permanence Sch Med, Pasadena, CA USA
[8] Univ Calif Los Angeles, Dept Hlth Policy & Management, Los Angeles, CA USA
关键词
Health Policy; Medicare; Outcomes Assessment; Patient-Centered Care; Pay for Performance; Physician-Patient Relations; Primary Health Care; Qualitative Research; Quality Improvement; FRAMEWORK;
D O I
10.3122/jabfm.2021.03.200555
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: While administrators of pay-for-performance may have good intentions, physicians may be reluctant to participate for various reasons, including poor program alignment with realities of clinical practice. In this study, we sought to characterize how primary care physicians (PCPs) participating in Medicare's Merit-Based Incentive Payment System (MIPS) conceptualize the quality of health care to help inform future measurement strategies that physicians would understand and appreciate. Methods: We performed semi-structured qualitative interviews with a nationwide sample of 20 PCPs in MIPS. We asked PCPs how they would characterize quality and what distinguished exceptional, good, and poor quality. Interviews were transcribed and 2 coders independently read transcripts, allowing data to emerge from the interviews and developing theories about the data. The coders met intermittently to discuss findings, harmonize the coding scheme, develop a final list of themes and subthemes, and aggregate a list of representative quotations. Results: Participants described quality as consisting of 2 components: (1) evidence-based care that is safe, which included health maintenance and chronic disease control, accurate diagnoses, and guideline adherence, and (2) patient-centered care, which included spending enough time with patients, responding to patient concerns, and establishing long-term relationships founded on trust. Conclusions: PCPs consider patient-centered care necessary for the provision of exceptional quality. Program administrators for quality measurement and pay-for-performance programs should explore new ways to reward PCPs for providing outstanding patient-centered care. Future research should be undertaken to determine whether patient-centered activities such as forging long-term, favorable patient-physician relationships, are associated with improved health outcomes.
引用
收藏
页码:590 / +
页数:19
相关论文
共 34 条
[1]  
[Anonymous], 2018, REP C
[2]  
[Anonymous], 2001, BRIT MED J
[3]  
[Anonymous], 2018, HDB NATL QUALITY POL
[4]   A conceptual framework for the OECD health care quality indicators project [J].
Arah, Onyebuchi A. ;
Westert, Gert P. ;
Hurst, Jeremy ;
Klazinga, Niek S. .
INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, 2006, 18 :5-13
[5]  
BARRIBALL KL, 1994, J ADV NURS, V19, P328
[6]   Primary Care Physicians in the Merit-Based Incentive Payment System (MIPS): a Qualitative Investigation of Participants' Experiences, Self-Reported Practice Changes, and Suggestions for Program Administrators [J].
Berdahl, Carl T. ;
Easterlin, Molly C. ;
Ryan, Gery ;
Needleman, Jack ;
Nuckols, Teryl K. .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2019, 34 (10) :2275-2281
[7]  
Busse R, 2019, EUROPEAN OBSERVATORY
[8]   US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures [J].
Casalino, Lawrence P. ;
Gans, David ;
Weber, Rachel ;
Cea, Meagan ;
Tuchovsky, Amber ;
Bishop, Tara F. ;
Miranda, Yesenia ;
Frankel, Brittany A. ;
Ziehler, Kristina B. ;
Wong, Meghan M. ;
Evenson, Todd B. .
HEALTH AFFAIRS, 2016, 35 (03) :401-406
[9]  
Centers for Medicare and Medicaid Services US Department of Health and Human Services, 2020, QPP PART STAT
[10]  
Centers for Medicare and Medicaid Services US Department of Health and Human Services, 2020, CAHPS MIPS SURVEY