Value-based payment contracts come with dozens of quality measures

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Physicians working with value-based payment models are being graded on an average of 57 different quality measures a year, according to a new study.

The quality measures were included in commercial and government insurance plans, with Medicare leading the number, with 15.04 quality measures per contract in 2022, according to “Value-Based Contracting in Clinical Care,” a research letter published this month in JAMA Health Forum.

Are the quality measures a burden on doctors?

“Value-based contracting is intended to incentivize care improvement, but it is unlikely a clinician or practice can reasonably optimize against 50 or more measures at a time,” the study said. “Increased use of such levers may also carry unintended consequences. Clarity and salience are crucial to changing behavior, and the burden of extraneous information and processes has been increasingly associated with adverse outcomes, such as physician burnout.”

The results

Researchers examined value-based contracts of 890 primary care physicians (PCPs) working with a mean of approximately 1,308 patients from 2020 to 2022. They found the number of value-based contracts increased per physician:

• 9.39 contracts with 54.78 unique quality measures in 2020
• 11.89 contracts with 64.08 unique quality measures in 2021
• 12.26 contracts with 52.37 unique quality measures in 2022

Medicaid had the fewest measures per contract, with a mean of 5.37 for the three-year period. Commercial insurance payment contracts had a mean of 10.07 for 2020, 2021 and 2022; and Medicare had a mean of 13.42 over the three years. The 2022 mean of 15.04 was the highest among the findings for measures per contract.

Measures hurting quality?

The researchers noted the data came from an integrated health system and may not generalize to other settings.

Even so, a Commonwealth Fund issue brief from July examined why most primary care physicians do not participate in value-based payment models. A key reason: “imperfect performance measures.”

“PCPs worry that current quality measures used in VBP models impede their ability to deliver high-quality care,” the study said.

Apart from the numbers of quality measures, in the Commonwealth Fund investigation, PCPs said coding for Hierarchical Condition Category risk scores in electronic health records took attention away from patients. They also argued documentation requirements are not aligned across models and payers, and the measures unfairly penalize them for outcomes beyond their control, according to “Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions,” published by The Commonwealth Fund.