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CMS Quality Measures Fall Short: A Call for New Measures in Primary Care

In a recent article published by Health Affairs, titled "Rethinking Primary Care Value: Time for New Measures," authors Bob Phillips, MD MSPH, and Rebecca Etz, PhD analyze the newly introduced Centers for Medicare & Medicaid Services "Universal Foundation," a framework aimed at aligning quality measures across its various programs, including primary care.

They point out that this framework falls critically short of the quality measures vital to effective primary care. 

We at Elation totally agree. While alignment is sorely needed and the efforts of the CMS are a step in the right direction, these measures fail the NASEM Health and Medicine Division criteria for primary care measures.

Primary care plays a vital role in the healthcare system of the United States. It shoulders the majority of the burden for the most commonly used clinical quality measures. However, despite this substantial effort to document and report on these measures, primary care derives little benefit from the current measurement system. In fact, the existing measures not only fail to capture the true essence of primary care—they undermine its very existence.

Primary care today requires a new set of measures - ones greater aligned with the professional values of primary care for which there is considerable evidence for successful outcomes and patient preferences. At Elation, we prefer measures like those in the Center for Professionalism and Value in Health Care’s Measures that Matter Initiative.

The value of primary care cannot be reduced to the mere monitoring of pathology; it encompasses the comprehensive care of individuals, the importance of building strong relationships, and the recognition of the full range of human experiences.

Quality measures that reflect the craft of primary care medicine and the sanctity of the provider-patient relationship are essential to defining success. These include, as Phillips and Etz point out, measures that recognize the value of continuity of care, person-centered care, and comprehensiveness. In addition, primary care teams advocate for their patients as they navigate the larger health system, coordinating care and providing a vital link across the healthcare continuum to reduce the serious consequences of fragmentation. All of these activities and characteristics create unique value and cannot be measured by a subset of services and processes, but rather by the qualities of the care delivery itself. 

It’s time to move away from measures that are solely tied to disease states and which add to clinicians’ burdens–and we must do it quickly. Primary care urgently needs a new set of measures; ones that reflect the incredible value primary care offers to patients, payers, the health system, and society.

Sara J. Pastoor, MD, MHA is Elation's Director of Primary Care Advancement and leader in primary care advocacy. Dr. Pastoor is a board certified and clinically active family medicine physician. Her experience as a primary care innovator spans a career in military medicine, academic medicine, private practice, and employer-sponsored delivery models. She received her MD from Rosalind Franklin University of Health Sciences and MHA from Trinity University.