• Carl T Berdahl, Molly C Easterlin, Gery Ryan, Jack Needleman, and Teryl K Nuckols.
• From the Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (CTB, TKN); Department of Emergency Medicine, Cedars-Sinai Medical Center, West Hollywood, CA (CTB); University of California, Los Angeles (UCLA) National Clinician Scholars Program (CTB, MCE); Department of Pediatrics, Cedars-Sinai Medical Center (MCE); Division of Neonatal Medicine, Department of Pediatrics, Los Angeles County and University of Southern California Medical Center (MCE); Kaiser Permanente School of Medicine, Pasadena, CA (GR); Department of Health Policy and Management, UCLA Fielding School of Public Health (JN). carl.berdahl@csmc.edu.
• J Am Board Fam Med. 2021 May 1; 34 (3): 590-601.

BackgroundWhile 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 health care to help inform future measurement strategies that physicians would understand and appreciate.MethodsWe 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 2 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 subthemes, and aggregate a list of representative quotations.ResultsParticipants described quality as consisting of 2 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 on trust.ConclusionsPCPs 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 long-term, favorable patient-physician relationships, are associated with improved health outcomes.© Copyright 2021 by the American Board of Family Medicine.

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