Quality of Quality Measures

Over the past decade, there have been substantial efforts to reduce the rate of medical errors and improve the overall quality of healthcare. Nonetheless, despite improvements in access to healthcare, higher utilization of healthcare services, and rising costs, there has been a limited association between quality metrics and consistent improvement in the quality of care. In 2010, the Affordable Care Act (ACA) developed a novel pay-for-performance (P4P) program that was designed to link financial incentives or penalty to provider performance. Simultaneously, government and nongovernment public reporting models have been developed to provide information regarding the performance of providers and payers and degree of patient satisfaction. These quality metrics that link payment to quality of outcomes were hypothesized to be an appealing strategy to address the limitations of the traditional fee-for-service approach that reimbursed healthcare providers solely based on the volume of services. Despite the importance of these metrics and their increasing implementation in quantifying quality of care, optimizing their efficacy and success remains an unmet need. This excessive “noise” surrounding quality metrics to select for important health outcomes has dramatically affected their use over time, raising arguments questioning the quality of these quality metrics.