A majority of healthcare providers feel the use of metrics and financial penalties linked with patient outcomes harms the quality of care, according to a new report.
As many as 50% of primary-care physicians, 40% of nurse practitioners, and 38% of physician assistants had a negative view of measuring provider performance, according to findings included in a new brief from the Commonwealth Fund and the Kaiser Family Foundation.
The perception of quality metrics did not improve much even among those providers who are being paid based on the quality of care. Only 28% of physicians receiving incentive payments felt the increased use of metrics to evaluate performance influenced their ability to provide quality care, compared with 17% of doctors not receiving incentive payments.
“One might think that those who are having more experience with those programs might be more comfortable with them,” said report co-author Liz Hamel, director of public opinion and survey research at the Kaiser Family Foundation. “At least so far, it seems like it's still negative across the board.”
Perhaps of most concern was how current healthcare trends are affecting retirement decisions. When physicians were asked whether changes in healthcare delivery and payment, medical homes and increased use of health information technology were causing them to consider early retirement, 47% reported they were considering retiring early compared with 34% of doctors who said trends were not a factor in their retirement plans. The study authors, however, were quick to point out that those findings reflect a 20-year trend of physician dissatisfaction.
Survey responses were collected between Jan. 5 and March 30, and included a random sample of 1,624 primary-care physicians, 366 nurse practitioners and 159 physician assistants working in primary-care practices.
A majority of providers saw the increased use of health IT as a positive when it came to improving quality of care delivery. Half of doctors and nearly two-thirds of nurse practitioners and physician assistants reported the advent of health IT as positively affecting clinical practice compared with more than a quarter of physicians and one-fifth of physician assistants who said it was having a negative effect.
Providers had more of a mixed view on the spread of patient medical homes and their impact on care quality. Around 33% of physicians and 40% of physician assistants believed the increased use of medical homes was improving the quality of care.
Positive feelings among providers regarding medical homes tended to increase based on their level of experience with such models. As many as 43% of doctors practicing in either a patient-centered medical home or in an advanced primary-care practice had a positive view of such organizations compared with just 28% of those not participating in those medical groups.
Half of primary-care physicians say the increased use of quality metrics to assess provider performance is quality of care. More than half of those physicians feel the same way about the penalties levied for readmissions
A study published last month in JAMA found 24% of the hospitals most likely to get a 1% penalty from the CMS on all Medicare revenue for failing to lower some hospital-acquired conditions were accredited by the Joint Commission.