The authors cite five examples of measures that could be adjusted and improved, including treatment of mild hypertension. Diet and exercise can be used to treat patients with a new diagnosis of mild hypertension, they wrote, and performance metrics should give doctors an incentive to go that route first before falling back on drugs, a strategy the authors called “accountable prescribing.”
The performance measurements should specify the order in which doctors prescribe competing drugs to treat the same condition, based on a ranking of research for outcomes and safety. When confronted with more than one appropriate option “cost can be an appropriate tiebreaker,” they wrote.
New efforts to tie payment to quality performance could incorporate such a strategy, the authors wrote.
Currently, physicians who hit quality targets for blood pressure or diabetes measures are rewarded without any regard for how the target was met, even when physicians bypass options that have better overall clinical results, lower costs or fewer risks, the Dartmouth doctors wrote in the New England Journal of Medicine. “Medications are the quickest and easiest way to reach the goal.”
Prescription drugs account for about 10% of U.S. healthcare spending. Retail sales of drugs to treat high blood pressure, diabetes and other ailments are projected to total $283.7 billion this year. And with the nation's largest insurance expansion in decades starting in January, spending on prescriptions is projected to soar 8.8% in 2014, federal actuaries say.
But not all of that spending is necessary, and prescription drugs have long been recognized as one source of potential savings in the nationwide effort to curb healthcare cost growth. One recent report by the IMS Institute for Health Informatics estimated the cost of prescription drug misuse to be $200 billion last year.
Closer attention to drug costs could be added to quality measures used by the one of Medicare accountable care experiments, the Shared Savings Program, the Dartmouth authors wrote.
Evolving quality measures present a critical challenge to efforts to more closely tie payment to performance, Morden said in an interview. “Efficient, meaningful quality measures are hard to develop, and this is just a start,” she said.