CMS, Health Plan Partners Release First Set of Aligned Quality Measures for Physicians

Feb. 17, 2016
The Centers for Medicare and Medicaid Services (CMS) and Americas Health Insurance Plans (AHIP), in collaboration, have released seven sets of standardized clinical quality measures for physician quality programs.

The Centers for Medicare and Medicaid Services (CMS) and America's Health Insurance Plans (AHIP), in collaboration, have released seven sets of standardized clinical quality measures for physician quality programs.

The core measure sets, developed by the new Core Quality Measures Collaborative, are intended to promote alignment of quality measures for the practitioner community or group practice level accountability and are in the following areas:

  • Accountable care organizations (ACOs), Patient-centered medical homes (PCMH), and primary care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics

Partners in the Collaborative recognize that physicians and other clinicians must currently report multiple quality measures to different entities. Measure requirements are often not aligned among payers, which has resulted in confusion and complexity for reporting providers. To address this problem, CMS, commercial plans, Medicare and Medicaid managed care plans, purchasers, physician and other care provider organizations, and consumers worked together through the Collaborative to identify core sets of quality measures that payers have committed to using for reporting as soon as feasible. The National Quality Forum (NQF) served as a technical adviser.

As such, this release is the first from the Collaborative, which plans to add more measure sets and update the current measure sets over time using the notice and public comment rulemaking process. “In the U.S. healthcare system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality,” CMS Acting Administrator Andy Slavitt said in a statement. “This agreement today will reduce unnecessary burden for physicians and accelerate the country's movement to better quality.”

It should be noted that CMS is already using measures from the each of the core sets. According to agency officials, several of the measures included in the core set require clinical data extracted from electronic health records (EHRs), are self-reported by providers, or rely on registries. While some plans and providers may be able to collect certain clinical data, a robust infrastructure to collect data on all the measures in the core set does not exist currently. The implementation of some measures in the core set will depend on availability of such clinical data either from EHRs or registries.  Providers and payers will need to work together to create a reporting infrastructure for such measures, CMS said.

CMS officials further said that this work is informing its implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) through its measure development plan and required rulemaking. CMS is using new tools from MACRA to support quality improvement and alignment. For example, MACRA provided additional funding to create and implement new measures where gaps exist and to align measures with the private sector. CMS has also developed a draft Quality Measure Development plan, which was informed by the development of the core measure sets and identification of key measure gaps. The plan is currently available for review and public comment.

Also included in the Collaborative, in addition to CMS and AHIP, are the American Academy of Family Physicians and the National Partnership for Women & Families. “Our healthcare system urgently needs measurement that drives improvements in quality, supports informed consumer decision-making and ensures we're paying for and incentivizing high-value care. What we released today is a start at achieving consensus on the best measures, but we need to continue pushing for even better ones,” said Debra L. Ness, president of the National Partnership for Women & Families.

“The AAFP’s involvement in the Collaborative is aimed at improving the quality of care while making family physicians’ lives easier by simplifying the information they are being asked to provide to payers,” added Douglas E. Henley, M.D., executive vice president and CEO of the American Academy of Family Physicians. “We are acutely aware of the huge amount of administrative complexity and burden that impacts the daily work of our members and diverts time and resources away from direct patient care. A major part of this is the burden of multiple performance measures in quality improvement programs with no standardization or harmonization across payers. This agreement on a set of core measures for primary care and the PCMH represents a big step toward the goal of administrative simplification for family physicians and improved quality of care.”

The Health Care Payment Learning and Action Network (HCPLAN), a public-private collaboration established by CMS, will integrate these quality measures into their efforts to align payment model components with public and private sector partners, the agency said. What’s more, CMS is working with federal partners including the Office of Personnel Management, Department of Defense, and Department of Veterans Affairs, as well as state Medicaid plans to align quality measures where appropriate.

Reaction to the Collaborative has started to trickle in. Members of the Charlotte, N.C.-based Premier healthcare alliance have commended CMS and private sector organizations participating in the Core Measures Collaborative for their work to create a single, consistent set of performance measures for primary care, accountable care organizations and specialties. 

In a statement, Blair Childs, Premier senior vice president of public affairs, said, “Historically, performance measures have varied widely across payers. In the public sector, there are more than 500 different state and regional quality measures, only 20 percent of which were used by more than one program. Private insurers contribute their own unique evaluation measures to the mix, for an additional 550 different measures. These conflicting and often contradictory measures not only lead to consumer confusion and provider ‘measurement fatigue, but also add considerable administrative expense.”

Childs continued, “Longstanding advocates for better and smarter performance measurement in healthcare, we believe a consistent set of measures is a good first step. However, it will be important that all measures be subject to public comment and measures testing to ensure scientific validity and avoid any unintended consequences, particularly before they are used to determine provider payment.  We look forward to reviewing the list of core measures and providing comment on their feasibility for inclusion in both public and private programs.”

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