Providers View Quality Metrics Negatively, Still Unsure of the Impact of ACOs

Half of primary care providers have generally negative views when it comes to the increased reliance on quality metrics to assess their performance, according to a new study from The Commonwealth Fund and Kaiser Family Foundation.

The study surveyed 1624 primary care physicians and 525 midlevel clinicians, such as nurse practitioners (NPs) and physician assistants (PAs).

Physicians are unhappier with quality metrics and financial penalties tied to patient outcomes, than midlevel clinicians, with 50% of physicians and 38% of NPs and PAs reporting that they feel the increased use of these metrics is having a negative impact on quality of care. In addition, 52% of physicians and 41% of NPs and PAs believe financial penalties are having a negative effect.

Midlevel clinicians and providers had very different views on team-based care. While 88% of NPs and PAs view emerging delivery models and tools that include a greater reliance on nonphysicians positively, only 29% of physicians agreed.

Providers were also divided on the increased use of medical homes and accountable care organizations (ACOs). Just a third of physicians and 40% of NPs and PAs believe medical homes are having a positive impact on quality of care. Those in practices receiving incentives or payments for qualifying as a patient-centered medical home were more likely to express positive views of the impact of medical homes.

Physicians are more likely to view the increased prevalence of ACOs negatively, while NPs and PAs were evenly split. Furthermore, physicians are largely unsure of the impact of ACOs. Even among physicians participating in an ACO, one-fourth said they are still unsure of the impact ACOs are having on healthcare quality of care.

Primary care providers do have more positive feelings about the use of health information technology (IT) and its impact on quality of care. Half of physicians and 64% of NPs and PAs say health IT has had a positive impact. Even though previous research has shown physicians dislike having to transition from paper-based records, they still accept the promise of health IT to improve care, according to the survey results.

“As primary care transformation efforts mature and spread, it will remain important to judge their effects on patients in terms of access, quality, and costs of care,” the authors concluded. “However, it is also important to assess their effect on primary care clinicians.”