Quality Metrics, Penalties May Harm Patient Care, PCPs Say

Megan Brooks

August 05, 2015

Half of US primary care physicians (PCPs) think the increased use of quality metrics to assess provider performance is having a negative effect on quality of care, according to a new survey from The Commonwealth Fund and the Kaiser Family Foundation.

Likewise, 52% of PCPs think programs that impose financial penalties for unnecessary hospital admissions or readmissions are having a negative effect on quality of care.

Nurse practitioners and physician assistants view quality metrics and admissions penalties somewhat more favorably but still are more likely to see negative effects than positive ones.

The Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers was conducted from January 5 through March 30, 2015, in a nationally representative sample of 1624 PCPs and 525 nurse practitioners and physician assistants working with PCPs.

Positive Opinions on Health IT

In contrast to quality metrics, health information technology (HIT) generally garnered positive opinions. Many PCPs think increased use of HIT will improve quality of care, the survey shows.

Exactly half of physicians and nearly two thirds (64%) of nurse practitioners and physician assistants think HIT will have a positive impact on practices' ability to provide quality care to their patients.

"Though seemingly counterintuitive, this finding is consistent with the literature: while providers tend to dislike transitioning from paper-based charts to electronic health record software, they generally accept the promise of HIT as a concept," the report notes.

In contrast, physicians' views tilt negative on the effect of accountable-care organizations (ACOs) on quality of care, and many are still not sure of their effect. Among physicians working in ACOs, views were divided between positive and negative.

About one quarter of PCPs view the growth in ACOs as having a negative impact on quality, while 14% view ACOs as having a positive impact on quality, but most see no impact or are unsure. Three in 10 PCPs (29%) surveyed say they currently participate in an ACO, and their views are more favorable, though still mixed (30% positive, 24% negative).

Three of 10 PCPs report that their practice is qualified as a patient-centered medical home or advanced primary care practice. About a third (33%) of PCPs view the increased use of medical homes as having a positive impact on quality, more than twice the proportion who see a negative impact (14%). Forty percent of nurse practitioners and physician assistants view the impact of medical homes as positive. Those who participate in medical homes are more apt to take a positive view than those who do not participate in medical homes.

Fifty-five percent of PCPs said they currently receive financial incentives based on quality or efficiency measures, although about a third continue to be paid exclusively on a fee-for-service basis.

Close to half (47%) of PCPs and 27% of nurse practitioners and physician assistants say the recent trends in healthcare are leading them to consider an earlier retirement. "This continues a 20-year trend of physician dissatisfaction with market trends in health care," the report notes.

The Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers. Published online August 5, 2015. Full text

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