JAMA Viewpoint: Where Do Measurement Costs Fit Into the Quality Equation?

In less than 20 years, the need to measure healthcare quality has become obvious. An infrastructure has grown up around the task of creating and validating measures, and deciding which ones CMS or commercial payers will use to connect pay with performance.

Measurement is here to stay, with CMS looking to tie 50% of all payments to value-based care by 2018 and physicians facing new requirements from the Medicare Access and CHIP Reauthorization Act.

But, as 3 authors in JAMA asked last week, is anyone keeping tabs on what measurement costs?

Mark A. Schuster, MD, PhD, and Sarah E. Onorato, BA, both of Boston Children’s Hospital and Harvard Medical School, and David O. Meltzer, MD, PhD, of the University of Chicago, took on this question in their essay, “Measuring the Cost of Quality Measurement: A Missing Link in Quality Strategy,” which observes that when selecting measures, cost is typically not a consideration. And that’s a problem, because the costs—especially data collection—can be considerable and the process time-consuming.

Then, the authors say, there’s the question of who pays. Are costs folded into hospital charges, insurance premiums, or other fees? Will the promise of electronic health records to bring down the cost of extracting data ever live up to the hype?

It’s time to be honest about the cost of measuring quality, the authors say. Bringing transparency and comparing the cost and value of similar measures would let the less useful (and less used) ones be discarded. An expensive measure that has high clinical value could be kept if its value can be demonstrated.

Cost should not be the only factor, they argue. But it has to be part of the equation, because doing so could inspire innovations to bring down the cost of the reporting process. That could also make things less burdensome for doctors and nurses if measurement fits better into the workflow.

The authors are not against measurement. “Measuring quality of care is essential to improving it,” they write. “However, the current, cost-uninformed approach has created a proliferation of measures, many of which are needlessly burdensome for health care organizations.”

If the point of measurement is to reveal what in healthcare has value, they authors say, the measures themselves have to pass muster.

Reference

Schuster MA, Onorato SE, Meltzer DO. Measuring the cost of quality measurement: a missing link in quality strategy [published August 31, 2017]. JAMA. 2017; doi:10.1001/jama.2017.11525