PCPI Helps Organizations Produce Clinically Valid Quality Measures

In medicine today, measures matter.

Quality measures are increasingly a fact of life for physicians as public and private payers move to performance-based reimbursement. How those measures are developed, whether they reflect clinical reality, and whether they really improve clinical care (or only complicate a physician’s practice) are crucial aspects of achieving the so-called Triple Aim of health care: improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care.

A vital player in this movement is PCPI (formerly known as the Physician Consortium on Performance Improvement), which encompasses 75 member organizations, including APA.

“PCPI partners with APA and other member groups to develop clinically relevant measures, and the broad scope of PCPI membership translates into leverage with the federal government and other payers,” said past APA President John McIntyre, M.D., chair of the PCPI Board of Directors.

Many parties, including the federal Centers for Medicare and Medicaid Services (CMS) and payers in the private sector, are developing quality measures—not all of them universally considered clinically valid. “If APA believes that certain measures being developed by the government or private insurers don’t make sense or don’t reflect psychiatric practice, PCPI carries a lot of weight in getting that measure reconsidered,” said McIntyre.

Some 360 measures have been developed by PCPI. “About a quarter have been endorsed by the National Quality Forum [a quasi-governmental clearinghouse for quality improvement measures], and many are used in pay-for-performance programs,” including the Medicare Quality Program’s Merit-Based Incentive Payment System (MIPS), he said.

Founded originally by the AMA, PCPI became an independent entity in 2015, dropping the full name and going by the acronym instead. Membership was opened to include—in addition to physician groups like APA—patient advocacy groups, pharmacies, insurance companies, and other stakeholders.

(McIntyre said PCPI is an “organization of organizations,” but a bylaws change under review would allow individual physicians to join.)

At the same time that PCPI became independent, it adopted a more decentralized model for developing measures and keeping them current, allowing PCPI members to directly manage measures relevant to their constituents.

For instance, last year APA and the American Academy of Neurology (AAN) developed new quality measures for management of dementia. The document, “Updated Dementia Management Quality Measures,” was written by a 26-member work group convened by the two associations and published in the American Journal of Psychiatry and Neurology (the journal of the AAN). It covers nine broad areas of assessment, diagnosis, and treatment (Psychiatric News, May 12, 2017).

Six of the measures have been included in MIPS. Under the “umbrella” of PCPI, APA participated in the development of quality measures for the treatment of major depression in adults (the product of a work group co-chaired by McIntyre), as well as for major depression in children and substance use disorders.

For those confused about the difference between quality “measures” and treatment “guidelines,” a performance measure (also referred to as a quality measure) is a specific set of documentable clinical judgments and actions. As past APA President John Oldham, M.D., formerly an APA representative to PCPI, put it, “The performance measure is a way of operationalizing a practice guideline.”

For instance, one of the nine areas addressed in the dementia measures is “Pain Assessment and Follow-Up for Patients With Dementia.” The measure addresses the percentage of patients with dementia who undergo documented screening for pain symptoms at every visit and the percentage of patients with a positive screen who have a documented follow-up plan for management of pain.

Today, PCPI’s work encompasses three areas:

• Quality improvement: What are best practices in various areas of clinical care? What works and what doesn’t? A recent project in this area is “Closing the Referral Loop.” McIntyre noted that there are more than 100 million referrals made every year, but very often the follow-up doesn’t happen, and patients are lost to care. “This is an effort by PCPI to try to improve communication among patients, referring physicians, and specialists to whom a patient is referred,” he said.

• Measurement science: This area encompasses the development of measures, but also the technical aspects of how to operationalize a specific measure in clinical practice. For instance, if a measure calls for use of the PHQ-9, what is a realistic expectation for how frequently it should be used in clinical practice for a population of patients? How can the instrument be embedded within an electronic health record?

• The National Quality Registry Network (NQRN): This is a voluntary network of PCPI member organizations that operate registries—such as APA’s PsychPRO—and those interested in increasing the usefulness of clinical registries to measure and improve patient health outcomes. The NQRN Steering Committee, an advisory committee to the PCPI Board of Directors, oversees PCPI’s NQRN Program.

Among the multitude of acronyms in American medicine, PCPI may be one of the more important ones for physicians to remember, and it is likely to become more central.

“It’s crucial for APA members to recognize that the federal government, as well as private payers, are increasingly paying doctors for performance, and reimbursement is going to be dependent on the demonstrated use of quality measures,” McIntyre said. ■