Carl T. Berdahl, MD, MS; Molly C. Easterlin, MD, MS; Gery Ryan, PhD; Jack Needleman, PhD; Teryl K. Nuckols, MD, MSHS
Corresponding Author: Carl T. Berdahl, MD, MS; Cedars-Sinai Medical Center. Email: carl.berdahl@csmc.edu
Section: Original Research
Publication: May 20, 2021
Background: While administrators of pay-for-performance may have good intentions, physicians may be reluctant to participate for various reasons, including poor program alignment with realities of clinical practice. In this study, we sought to characterize how primary care physicians (PCPs) participating in Medicare’s Merit-Based Incentive Payment System (MIPS) conceptualize the quality of healthcare to help inform future measurement strategies that physicians would understand and appreciate. Methods: We performed semi-structured qualitative interviews with a nationwide sample of 20 PCPs in MIPS. We asked PCPs how they would characterize quality and what distinguished exceptional, good, and poor quality. Interviews were transcribed and two coders independently read transcripts, allowing data to emerge from the interviews and developing theories about the data. The coders met intermittently to discuss findings, harmonize the coding scheme, develop a final list of themes and sub-themes, and aggregate a list of representative quotations. Results: Participants described quality as consisting of two components: (1) evidence-based care that is safe, which included health maintenance and chronic disease control, accurate diagnoses, and guideline adherence and (2) patient-centered care, which included spending enough time with patients, responding to patient concerns, and establishing long-term relationships founded upon trust. Conclusions: PCPs consider patient-centered care necessary for the provision of exceptional quality. Program administrators for quality measurement and pay-for-performance programs should explore new ways to reward PCPs for providing outstanding patient-centered care. Future research should be undertaken to determine whether patient-centered activities such as forging Abstract long-term, favorable patient-physician relationships, are associated with improved health outcomes.