Quality Reporting Costs $40,000 per Physician per Year

Bridget M. Kuehn

March 07, 2016

As the drive for value-based care advances, US medical practices in just four specialties spend an estimated $15.4 billion each year reporting whether they are meeting their quality targets, according to a survey.

The results of the survey, which were published in the March issue of Health Affairs, bolster anecdotal reports from physicians about the increasing cost and time burden associated with reporting quality measures to insurers, according to Lawrence P. Casalino, MD, PhD, MPH, from the Department of Health Care Policy at Weill Cornell Medical College in New York City, and colleagues.

There is little standardization of quality measures, which may include mammography rates or hemoglobin A1c levels for patients with diabetes. Individual insurers may require physicians to report on hundreds of quality measures with little overlap in the measures used by different insurers, according to the authors.

"Anecdotally, dealing with these measures imposes a considerable burden on physician practices in terms of understanding the measures, providing performance data, and understanding performance reports from payers, but the extent of that burden has not been quantified," the authors write.

To quantify this burden, the authors randomly selected 1000 practices from the Medical Group Management Association's membership rolls and asked them to fill out web-based survey. The authors surveyed 250 practices from each of four specialties: cardiology, orthopedics, primary care, and multispecialty. The response rate was 39.4% overall, but increased to 54.3% with adjustments for unreachable practices or practices outside the four specialties.

Physicians and staff at the surveyed practices reported spending 15.1 hours per week per physician on quality measures. On average, physicians spent 2.6 hours per week on quality measures, and the remaining hours fell to staff, primarily licensed practical nurses or medical assistants, according to the survey results. Most of the time was spent on data entry strictly used for quality measures.

Primary care physicians spent the most time (3.9 hours per week) on quality measures, followed by physicians in multispecialty practices (3.0 hours per week), cardiologists (1.7 hours per week), and orthopedists (1.1 hours per week), according to the survey results.

All the time practices spend on quality measure reporting adds up to a considerable expense, with an average cost of $40,069 per physician per year, according to the survey results. The authors estimate this translates to $15.4 billion in annual spending on quality measure reporting just for US physicians in the four types of practices represented in the survey. More than 80% of the practices report that the effort spent on quality reporting has increased compared with 3 years ago.

"The cost to physician practices of dealing with quality measures is high and rising," the authors note.

One of the factors likely driving the increasing burden of quality reporting on practices is a growing shift by public and private insurers toward value-based care. The goal of the reporting is to help tie physician reimbursements to the quality of care they provide. Recent developments such as the passage of the Medicare Access & CHIP Reauthorization Act of 2015, which aims to accelerate Medicare's use of value-based payments to physicians, are likely to further increase the emphasis on quality reporting, observe the authors.

"There is much to gain from quality measurement, but the current system is far from being efficient and contributes to negative physician attitudes toward quality measures," the authors write.

However, they also note that efforts to reduce the number of quality measures and to standardize them across insurers are gaining momentum.

"Our data suggest that US health care leaders should make these efforts a priority," they conclude.

The study was funded by the Physicians Foundation. The authors have disclosed no relevant financial relationships.

Health Aff. 2016;35:401-406. Abstract

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