Background: Physician reimbursement and healthcare financing is increasingly driven by value-based payment. Physician and system evaluation of quality of care is frequently defined by performance measures. This may improve clinical outcomes if performance measures used are appropriate.Implementation and compliance with inappropriate performance measures can increase use of unnecessary medical services, consequent harms to patients, waste of resources, and decreased patient and physician satisfaction. In the USA,, primary care physicians participating in the Medicare Merit-based Incentive Payment System (MIPS) must choose at least 6 out of 65 outpatient performance measures for which they will be evaluated, including at least one outcome measure.

Objectives: Report on the appropriateness of the 65 primary care performance measures in MIPS for 2017.

Methods: We developed four appropriateness criteria for performance measures (convincing evidence, benefits outweigh harms, adequate specification of population and adequate specification of intervention) using evidence-based principles and experience evaluating performance measures, guidelines and evidence. We evaluated the 65 performance measures in MIPS. Systematic searches of PubMed, relevant organisational guidelines, and DynaMed Plus were used to determine the presence of convincing evidence. Three physician raters with methodologic expertise and subject matter expertise rated all measures and reached consensus for final ratings

Results: Preliminary results (pending complete ratings and consensus) for 65 performance measures::
21 measures (32%) meet criteria for appropriateness
25 measures (38%) meet criteria for appropriateness with suggested modifications
19 measures (29%) do not meet criteria for appropriateness

Conclusions: Most MIPS performance measures lack evidence to support their use or specificity for appropriate implementation. Clinicians and administrators can use this systematic approach to identify and implement higher-quality, evidence-based performance measures. This will minimise inappropriate medical resource utilisation.and improve overall clinical care.