More About Measures
PRIME Registry has become an important platform for developing and testing high-value primary care measures and getting them endorsed by CMS for MIPS reporting.
The PRIME Registry measure set currently includes two MIPS-approved measures that were developed as part of the Measures That Matter initiative: PRIME 133 Person-Centered Primary Care Measure Performance Measure (PCPCM-PM) and PRIME 100 Measuring the Value-Functions of Primary Care: Provider Level Continuity Measure.
These measures are available for use by any PRIME Registry practice. Simply let your PRIME Registry account representative at FIGmd know you want to include one or both of these measures in your practice selection.
More on PRIME 133-PCPCM-PM
PRIME 133 is a patient-reported measure of exemplary primary care that has been developed by the Larry A. Green Center, based on extensive development work with patients, clinicians and health care payers. The measure is the winner in the Patient-Reported Outcomes category of the National Quality Forum (NQF) Next-Generation Innovator Abstract Award.
The Person-Centered Primary Care Measure (PCPCM) focuses attention and support on the integrating, personalizing, and prioritizing functions that patients and clinicians say are important. A measure based on these principles may reduce both the de-personalization experienced by patients, and the measurement burden, burnout and crisis of meaning experienced by clinicians.
The PCPCM uses a survey to ask patients to assess 11 distinct yet highly interrelated items regarding their assessment of the care they receive. The 11 items were developed with input from hundreds of patients and physicians, and are associated with better personal and population health, equity, quality and costs.
PRIME 133 data can be analyzed further via the PRO tool [will link to PRO tool info on site] in your PRIME Registry dashboard.
More on PRIME 100 Measuring the Value-Functions of Primary Care: Provider Level Continuity Measure
Continuity of Care, defined as seeing the same primary care clinician over time, remains one of the pillars of a high functioning health care system. Continuity of Care is shown to improve patient outcomes and clinician well¬being, decrease hospitalization risk and decrease levels of spending. When continuity is poor, it suggests fragmented care and an associated lack of a trusting relationship in primary care. The Continuity of Care measure, developed in collaboration with the Robert Graham Center, is based on claims data, so no special effort is required by the clinician to collect and track measure results.
The Measures That Matter are a suite of four clinical quality measures that the American Board of Family Medicine endorses for simplifying and improving measurement of Primary Care.
A More Meaningful Standard for Primary Care
Whole-person clinical quality measures are the underpinning of what matters in primary care. They are relevant to all communities, in all public health situations, and across all diseases, providing a way to quantify patient-centered quality care.
Measures That Matter focus on more personalized care, taking into account what matters to both patients and clinicians. While current clinical quality measures focused on disease specific care have value, they are not aligned with the foundations of primary care or the needs of patients, communities, and health systems.
Measures That Matter are designed for use across multiple levels of the health care system:
Primary Care Practices
- Meet patient needs by focusing attention on what matters
- Reduce burnout and burden by organizing practice around the reason they went into patient care
Employers
- Assess if the care they are purchasing is doing what patients, clinicians and payers have identified as what matters
- Require that systems support aspects of primary care that matter
Patients
- Participate in health care improvement
- Provide information important for caring for them as a whole person
Insurers and Healthcare Systems
- Identify where to invest to support those delivering high quality primary care
- Develop systems that support integrating, personalizing and prioritizing care
The Person-centered Primary Care Measure (PCPCM) is a patient-reported measure of exemplary primary care that has been developed by the Larry A. Green Center based on extensive development work with patients, clinicians and health care payers. The measure is the winner in the Patient-Reported Outcomes category of the National Quality Forum (NQF) Next-Generation Innovator Abstract Award.
The PCPCM focuses attention and support on the integrating, personalizing, and prioritizing functions that patients and clinicians say are important. A measure based on these principles may reduce both the de-personalization experienced by patients, and the measurement burden, burnout and crisis of meaning experienced by clinicians.
The PCPCM uses a survey to ask patients to assess 11 distinct yet highly interrelated items regarding their assessment of the care they receive. The 11 items were developed with input from hundreds of patients and physicians, and are associated with better personal and population health, equity, quality and costs.
The PCPCM is now featured in the PRIME Registry Measure Set and available for use as a MIPS (Merit-based Incentive Payment System) measure.
Continuity of Care was developed in collaboration with the Robert Graham Center and uses the Bice-Boxerman Continuity of Care Primary Care Physician Measure. At a patient-level, Bice-Boxerman Continuity of Care is a measure that considers the dispersion of primary care visits across providers, such that patients with higher scores have most of their primary care visits to the same provider or a small number of providers while those lower scores see a larger number providers.
Continuity of Care Measure is also featured in the PRIME Registry Measure Set, and available for use as a MIPS (Merit-based Incentive Payment System) measure.
The Low-Value Care measure is also in the conceptualization phase in collaboration with Mount Sinai. Low-Value Care is an attempt to give feedback on modifiable behavior as a mechanism to improve primary care’s well documented moderation of total health care spending. Key to the measurement and reporting of total cost of care is our effort to develop and test Low-Value Care measures that can help clinicians identify specific, modifiable behaviors. Testing of this measure sets up capacity for long-term evaluation of feedback on practicing clinicians and their behaviors and on total cost of care.
Phase 1: Conceptualization
Information Gathering
Measure development begins with information gathering – the measure developer conducts an environmental scan, develops a business case and requests input from a broad group of stakeholders including patients. The developer then narrows down the concepts to specific measures.
Phase 2: Specification
Draft Specifications
After the information gathering phase, we begin to draft the measure specifications. Measure specifications provide the comprehensive details that allow the measure to be collected and implemented consistently, reliably, and effectively. The specifications identify the population, the recommended practice, the expected outcome and determine how it will be measured. They also may include age ranges, performance time period and allowable values for medical conditions or procedures, code systems, descriptions.
Measure technical specifications will address the following questions: How will the measure be named? Does the name mean anything to people when they read it? Do they understand what that measure is about? What would the setting of the measure be (e.g., ambulatory office)? How will the data be collected? These questions have to be answered before testing begins.
Harmonization is all about reducing burden. Look at measures currently in practice and determine if there are places where our measure could be harmonized with the existing measure(s).
Phase 3: Testing
Measure Testing
Measure testing assesses the suitability of the quality measure’s technical specifications and acquires empirical evidence to help assess the strengths and weaknesses of a measure. Measure testing involves testing the components of the quality measure such as the data elements, the scales (and items in the scales if applicable), and the performance score.
There are two parts to measure testing: alpha and the beta testing.
Alpha testing helps identify early issues and often begins as early as the conceptualization step and is repeated during the development of the measure specifications.
Beta testing, which is also referred to as field testing, generally occurs after the initial specifications have been developed, and strives for representative sample sizes – multiple sites/settings. The primary purpose for beta testing is to understand the usability of the measure and to test the scientific acceptability of the measure.
After the testing ends, the results are analyzed with a return to the specification phase, or even the conceptualization phase, to rework the measure before testing again.
The PRIME registry is ABFM’s Qualified Clinical Data Registry (QCDR) and serves as our measure testing bed.
Phase 4: Implementation
Measure Implementation
The measure is then submitted for NQF endorsement (not a requirement for use by CMS) and for use in the 18 CMS quality reporting and payment programs.
What’s the difference between submitting to CMS versus submitting to NQF?
The National Quality Forum (NQF) submission is about the endorsement process where a consensus-based entity reviews the measure using five evaluation criteria to assess the measure on its own merit and independent of a CMS program. It essentially gives it that stamp of approval, and so endorsement/NQF submission is separate from CMS implementation. NQF endorsement is valued for measures in CMS programs, but it is not a requirement.
The CMS implementation process takes the measure from being in development to being actively used in 18 of the CMS quality payment programs (QPP).
Phase 5: Use, Continuing Evaluation, and Maintenance
Re-evaluation
This step ensures that the measure continues to add value to quality reporting measurement programs and that its construction continues to be sound. The regular reevaluation of measures is vital as the science and other factors are always changing (e.g., development of new clinical guidelines, new technologies for data collection, discovering a better way to calculate measure results). Continually reviewing the measure will ensure it remains relevant and meaningful. Measures that stop being useful are retired.
Interaction Among Measure Lifecycle Phases
The Measure development lifecycle is not a linear process. Once the measure is conceptualized, it can move throughout the various phases in the measure development lifecycle.
The following decision criteria throughout the measure development cycle ensures a measure meets the applicable standards before moving to the next phase:
Importance to measure and report—including analysis of opportunities for improvement such as reducing variability in comparison groups or disparities in healthcare related to race, ethnicity, age, or other classifications.
Scientific acceptability—including analysis of reliability, validity, and exclusion appropriateness.
Feasibility—including evaluation of reported costs or perceived burden, frequency of missing data, and description of data availability.
Usability—including planned analyses to demonstrate that the measure is meaningful and useful to the target audience. This may be accomplished by the Technical Expert Panel (TEP) reviewing the measure results such as means and detectable differences, dispersion of comparison groups, etc. More formal testing, if requested by CMS, may require assessment via structured surveys or focus groups to evaluate the usability of the measure (e.g., clinical impact of detectable differences, evaluation of the variability among groups).
We are grateful for the collaboration and support of our current partners in this initiative.
Interested in opportunities to collaborate or support this initiative?
Contact Jill Shuemaker
Related Publications
A New Comprehensive Measure of Primary Care
Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations:
More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalizations:
Primary Care Physician Characteristics Associated with Low Value Care Spending:
