Top administrative challenges of 2023: Quality metric reporting

Editor's Note: Every year, Medical Economics® asks our physician readers what challenges they are facing in their practices. And every year, we get the same answer as the top challenge: administrative burdens.For our first issue of 2023, we decided to take a stab at fleshing out what some of those administrative burdens are and what physicians can do about them in their practice. We focused on five administrative burdens that our readers commonly tell us are major issues.

Quality metric reporting can be a significant challenge to health care administration due to a number of obstacles. First and foremost, you need buy-in from the physicians providing the care to the patients. Without this, it is difficult to make any meaningful changes to the pattern of care provided.

Second, it requires having a very robust quality and data analytics team in your health care system. The startup costs for this can be very high, and it may not always be easy to quantify the direct reimbursement seen from this.

“As medical practitioners, we strive to provide great quality care to our patients,” says Marc Afman, D.O., medical director of Clinical Integrated Network with University of Michigan Health-West in Wyoming, Michigan. “However, improving quality at the expense of increased costs does not lead to improved value to the community and the patients we serve. This has been a major paradigm shift on how we have practiced medicine in the past.”

Previously, he explains, physicians worked only in a fee-for-service environment with less emphasis placed on quality. In today’s health care landscape, physicians are asking providers to find the balance between providing exceptional quality to patients while still being mindful of the costs incurred to obtain this.

“A large focus of our efforts is on quality initiatives and reporting,” Afman says. “We are continually working with various payers on how to improve the quality of care provided from the payer perspective. Sometimes it comes down to making simple changes to the level of specificity of diagnosis coding or including additional appropriate diagnosis codes that explain the medical decision-making process (to determine) whether or not we get credit for some quality measures.”

Researchers have found that consumers are interested in quality measures that convey information about a physician’s technical care and interpersonal skills. Typically, technical quality is measured using clinical information found in administrative databases, electronic health records or medical charts, whereas interpersonal quality is measured using patient surveys.

The patient is always the first and foremost priority, but it’s now also important for physicians to maintain high-quality scores to be able to earn the reimbursement and quality ratings that enable the health system to continue to take care of the patient.

Leah Alexander, M.D., a pediatrician at PediatriCare Associates in Fair Lawn, New Jersey, notes that the quality of health care is important to patients, providers and payers and that in an effort to improve quality and value, many organizations are now focusing on quality metric reporting.

Although this can be a useful tool, it also presents some challenges.

“There is no standard definition of what constitutes a ‘quality’ metric,” she says. “This can make it difficult to compare data across different organizations. Additionally, collecting accurate data can be challenging. For example, electronic health records ... may not always capture all the relevant data points.”

Another challenge is that quality metrics often focus on process measures rather than outcome measures. This can make it difficult to assess whether a particular intervention is actually improving patient care. Also, some quality metrics may be subject to gaming, meaning that providers may focus on meeting the metric rather than on providing high-quality care.

“Despite these challenges, quality metric reporting can be a useful tool for improving quality and value in health care,” Alexander says. “To overcome the challenges, it is important to work with an experienced partner who can help you collect accurate data and interpret (these data) in a way that will improve patient care.”

Additionally, it is important to focus on outcome measures rather than process measures. By doing so, physicians can ensure that quality metrics are actually making a difference in the lives of their patients.