title: The present and future of quality measures and public reporting in neurosurgery.
abstract: Quality measurement and public reporting are intended to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. However, regulatory implementation has created a complex network of reporting requirements for physicians and medical practices. These include Medicare's Physician Quality Reporting System, Electronic Health Records Meaningful Use, and Value-Based Payment Modifier programs. The common denominator of all these initiatives is that to avoid penalties, physicians must meet "generic" quality standards that, in the case of neurosurgery and many other specialties, are not pertinent to everyday clinical practice and hold specialists accountable for care decisions outside of their direct control. The Centers for Medicare and Medicaid Services has recently authorized alternative quality reporting mechanisms for the Physician Quality Reporting System, which allow registries to become subspecialty-reporting mechanisms under the Qualified Clinical Data Registry (QCDR) program. These programs further give subspecialties latitude to develop measures of health care quality that are relevant to the care provided. As such, these programs amplify the power of clinical registries by allowing more accurate assessment of practice patterns, patient experiences, and overall health care value. Neurosurgery has been at the forefront of these developments, leveraging the experience of the National Neurosurgery Quality and Outcomes Database to create one of the first specialty-specific QCDRs. Recent legislative reform has continued to change this landscape and has fueled optimism that registries (including QCDRs) and other specialty-driven quality measures will be a prominent feature of federal and private sector quality improvement initiatives. These physician- and patient-driven methods will allow neurosurgery to underscore the value of interventions, contribute to the development of sustainable health care solutions, and actively participate in meaningful quality initiatives for the benefit of the patients served.
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire;
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.affiliation: Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina;
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.affiliation: Departments of 3 Neurosurgery and.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.affiliation: Department of Neurosurgery, University of Utah, Salt Lake City, Utah;
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Holland
authors.affiliation: Department of Neurological Surgery, State University of New York at Buffalo, New York;
authors.forename: Jason
authors.initials: J
authors.lastname: Davies
authors.affiliation: Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.affiliation: Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina;
authors.forename: Tyler
authors.initials: T
authors.lastname: Atkins
authors.affiliation: Department of Neurological Surgery, Atlantic Neurosurgical Specialists, Morristown, New Jersey;
authors.forename: Jack
authors.initials: J
authors.lastname: Knightly
authors.affiliation: Clinical Affairs and Quality Improvement, Hart Health Strategies, Inc., Washington, DC; and.
authors.forename: Rachel
authors.initials: R
authors.lastname: Groman
authors.affiliation: American Association of Neurological Surgeons, Rolling Meadows, Illinois.
authors.forename: Irene
authors.initials: I
authors.lastname: Zyung
authors.affiliation: Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina;
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Asher
mesh_terms: D005544:Forecasting; D006801:Humans; D009493:Neurosurgery / Q000379:methods* / Q000639:trends*; D011785:Quality Assurance, Health Care / Q000379:methods / Q000639:trends; D011787:Quality of Health Care
keywords: CEHRT = certified EHR technology; CMS = Centers for Medicare and Medicaid Services; Centers for Medicare and Medicaid Services; EHR = electronic health record; EP = eligible professional; MACRA = Medicare Access and CHIP Reauthorization Act; MIPS = Merit-Based Incentive Payment System; N2QOD = National Neurosurgery Quality and Outcomes Database; NQF = National Quality Forum; PQRS = Physician Quality Reporting System; Physician Quality Reporting System; QCDR = Qualified Clinical Data Registry; Qualified Clinical Data Registry; VM = Value-Based Payment Modifier; quality measures; value