Should Doctors Be Penalized for Patient Outcomes?

Leigh Page


November 03, 2016

In This Article

The Move Toward Outcome Measures

Being held accountable for outcomes is still fairly rare, but it's becoming an important ingredient in quality assessments.

Medicare's Physician Quality Reporting System (PQRS) requires doctors to report process measures—for example, the percentage of patients with coronary artery disease for whom the physician has prescribed aspirin or clopidogrel.

Already, PQRS allows physicians to select from a small number of outcome measures (eg, the percentage of patients who require intubation after coronary artery bypass graft surgery), but they are not required to do so.

Next year, however, thanks to the Medicare Access and CHIP Reauthorization Act (MACRA), PQRS will be replaced by the quality performance (QP) category of the Merit-Based Incentive Payment System (MIPS). Under MIPS QP measures, which start in January 2017, physicians will have to choose one quality measure out of a total of six measures to report.

Furthermore, MACRA anticipates that physicians will eventually assume financial risk for lowering costs and assuring quality. These arrangements include shared savings in accountable care organizations (ACOs), bundled payments, and episodes of care.

All of these programs will rely on better patient adherence, which can be daunting for many physicians. According to a 2005 meta-analysis,[1] nonadherence rates can exceed 40%.


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