Feature June 1, 2022 John Bernot, MD

Physician opinion: Quality metrics fail to measure improved outcomes

Do current quality metrics effectively measure improved health outcomes? Answer the survey.

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According to the Centers for Medicare and Medicaid Services (CMS), quality measures are tools to “measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.”1

These measures incentivize the industry to improve the quality of care, reduce healthcare costs, and more broadly support the transition from fee-to-service to value-based care (VBC).2 

However, there is limited evidence that the quality measures tied to incentives lead to improved outcomes.3

Further, despite the proliferation of quality measures and alternative payment programs, healthcare costs in the U.S. continue to skyrocket with no deceleration in sight. Health spending increased by 9.7% from 2019 to 2020, much faster than the 4.3% increase from 2018 to 2019.4

While I do not support throwing out quality measures altogether and starting over, I believe the industry must find a way to overcome the attribution challenge of identifying and measuring what leads to improved outcomes and adopting value-based care more holistically.   

Read on to find out why. 

The challenge of attribution

It is easy to attribute quality measures related to the process of healthcare delivery, such as did a patient have their A1C level tested for a scheduled diabetes screening. As such, quality measures of processes work well in our existing healthcare environment. 

However, attribution gets murky when looking at outcomes measures such as readmissions, the safety of care (including HAIs), patient-reported outcomes, and more. 

It takes a village to deliver the best care and attempting to identify the interactions a patient had in their healthcare journey that had a direct impact on improved outcomes—which crosses providers, specialists, health networks, and more— is near impossible. 

There are currently over 150 attribution models in use or proposed5 attempting to measure this. And yet, attribution is as elusive as ever. 

Further, lack of attribution means a lack of accountability—if everyone is responsible for outcomes, then nobody is. 

Embracing value-based care is essential

Limited adoption of VBC across the industry only exacerbates the problem of accountability for quality measures.

In 2020, approximately 40% of healthcare payments came from value-based reimbursement models, representing only a modest increase over 2019.6

With only one toe in VBC, the industry has no incentive to work harder to identify the quality measures that improve outcomes—the lack of urgency is deafening. 

Until healthcare organizations embrace VBC more fully, quality measures simply cannot be the incremental change needed to identify and ultimately improve health outcomes.

What do you think?

Do current quality metrics effectively measure improved health outcomes? Answer the survey and share your comments in the poll.


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  1. Quality Measures. Centers for Medicare & Medicaid Services.
  2. Quality Measures: How to Get Them Right. Fam Pract Manag. 2018;25(4):23-28.
  3. Care that Matters: Quality Measurement and Health Care. PLoS Med. 2015 Nov; 12(11): e1001902.
  4. How has U.S. spending on healthcare changed over time? Peterson-KFF Health System Tracker.
  5. Modernizing Medical Attribution. Journal of General Internal Medicine volume 35, pages3691–3693 (2020).
  6. The State of Value-Based Reimbursement, Financial Risk in Healthcare. RevCycle Intelligence.