Becker's Hospital Review

84 CMO / CARE DELIVERY Study: Only 37% of physician care quality measures are valid By Megan Knowles A lthough U.S. physicians are evaluated on over 2,500 performance measures, less than 40 percent of these metrics are considered valid, according to a study pub- lished in e New England Journal of Medicine. To determine the validity of these performance measures, a committee for the American College of Physicians created a five-item checklist to measure importance, appropriateness, strength of clinical evidence, feasibility of implementation and applicability. e ACP committee analyzed 86 performance measures perti- nent to general internal medicine practice. e measures were part of the Medicare's Merit-based Incentive Payment System/ Quality Payment Program, which aims to connect physician performance and patient outcomes to reimbursement. CMS aims to link 90 percent of physician payments under Medicare's fee-for-service system to performance metrics be- fore 2019. However, the agency requested proposals for revised measures. "We hypothesized that if most of the measures as- sessed were deemed valid using this process, physicians could have more confidence that adherence to the measures would result in improved patient outcomes," the study authors wrote. Only 37 percent of quality measures the ACP committee as- sessed met their validity criteria. Of the remaining measures, 35 percent were deemed invalid while 28 percent had uncertain validity. "Quality measures only should be based on practices about which we are certain there is a meaningful health benefit. ere should be no controversy in quality measures," said lead re- searcher Catherine MacLean, MD, PhD, in a press release. e study authors emphasized they are not dismissing the need for performance measures for physicians, but call for changes to the way the assessments are created. One step toward changing how these assessments are developed is to avoid placing too much reliance on administrative data, such as billing claims, since they lack detailed information and nuance, the study authors noted. Additionally, the assessments should move toward a system where physicians receive feed- back on their performance in real time as opposed to being evaluated long aer they deliver care. "e point of the paper isn't that we don't support quality mea- sures. We've had careers in developing them," Dr. MacLean said. "e problem is that bad quality measures can be harmful. Additionally, they are a waste of time; they're frustrating, and they're a waste of money. It's gotten to the point where it's al- most measures for measurement's sake." n 1 in 3 CNOs admit nursing shortages are harming patient care By Megan Knowles A s nursing shortages continue to challenge hospitals and health systems, over one-third of chief nursing officers said these shortages negatively affect patient care, with more CNOs viewing shortages as detrimental to patient satisfaction, according to a survey conducted by nurs- ing care facilities company AMN Healthcare. The survey measured how CNOs and other nurse leaders viewed the effects of nursing shortages across the healthcare industry. "Nurse leaders are increasingly concerned about worsening nurse shortages and their impact on patient and staff satis- faction, as well as nurse recruitment," said Marcia Faller, PhD, RN, chief clinical officer at AMN Healthcare. "This survey also suggests that finding effective solutions to this situation may be beyond the capabilities of most healthcare organizations. They are going to need help, especially as nurse shortages get worse." Here are six survey findings. 1. The majority of CNOs acknowledged their healthcare or- ganizations are currently experiencing some level of nurse shortages, with 72 percent describing the shortages as mod- erate, significant or severe. Only 7 percent of respondents said there is no shortage. 2. Additionally, most CNOs believe the shortages would get worse over the next five years, with 28 percent of CNOs pre- dicting a worsening in one year, 43 percent in two years and 61 percent in five years. 3. Over 80 percent of CNOs described challenges in recruit- ing nurses at their organization as moderate, significant or se- vere. Forty-one percent described it as significant or severe. 4. Thirty-four percent of CNOs said nurse shortages have a considerable or great negative impact on patient care. When asked about patient satisfaction, 41 percent viewed nurse shortages as considerably or greatly detrimental to how pa- tients feel about their care. 5. The majority of CNOs (61 percent) said shortages have a considerable or great negative impact on nurse morale, which is linked to patient satisfaction and patient care quality. 6. When asked about their nurse recruitment problems, CNOs said the two greatest challenges are lack of access to high-quality talent (32 percent) and their organization's loca- tion (37 percent). n

• Cover