The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced the agency’s efforts to streamline quality measures and reduce regulatory burden with a new approach to quality measurement called “Meaningful Measures.”
Verma announced the “Meaningful Measures” initiative on Monday during a plenary session at the Health Care Payment Learning and Action Network (LAN) Fall Summit in Arlington, Virginia, and CMS published a written text of her speech on its website.
“Since assuming my role at CMS, we are moving the agency to focus on patients first. To do this, one of our top priorities is to ease regulatory burden that is destroying the doctor-patient relationship. We want doctors to be able to deliver the best quality care to their patients,” Verma said in her speech.
“We often hear about this term – ‘regulatory burden’ – but what does it actually mean? Regulations have their place and are important to ensuring quality, integrity, and safety in our health care system. But, if rules are misguided, outdated, or are too complex, they can have a suffocating effect on health care delivery by shifting the focus of providers away from the patient and toward unnecessary paperwork, and ultimately increase the cost of care,” Verma said.
According to CMS, Meaningful Measures will involve only assessing those core issues that are most vital to providing high-quality care and improving patient outcomes. The agency aims to focus on outcome-based measures going forward, as opposed to trying to micromanage processes, the agency stated.
“We need to move from fee-for-service to a system that pays for value and quality – but how we define value and quality today is a problem,” Verma stated. “We all know it: Clinicians and hospitals have to report an array of measures to different payers. There are many steps involved in submitting them, taking time away from patients. Moreover, it’s not clear whether all of these measures are actually improving patient care.”
Meaningful Measures takes a new approach to quality measures to reduce the burden of reporting on all providers by drawing on advice and input from the LAN as well as the National Academies of Medicine, the Core Quality Measures Collaborative, and the National Quality Forum, CMS said.
Verma’s remarks regarding quality measurement come a few days after the public launch of the agency’s “Patients Over Paperwork” Initiative, what CMS calls “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies, and improve the beneficiary experience.”
Administrator Verma was joined by 35 provider associations and organizations for that earlier launch, including the American Hospital Association, the American Academy of Family Physicians, and LeadingAge. Through the launch of the Patients Over Paperwork Initiative, CMS, along with its partners and stakeholders, emphasized its commitment to removing regulatory obstacles that get in the way of providers spending time with patients.
In her speech Verma cited a report from the American Hospital Association, published last week, that indicates health systems, hospitals, and post-acute care providers must comply with 629 mandatory regulatory requirements. What’s more, the AHA report found that providers are dedicating approximately $39 billion a year to comply with the administrative aspects of regulatory compliance. This report also showed that an average-size hospital dedicates 59 full time employees to regulatory compliance, over one quarter of which are doctors and nurses.
According to Verma, the agency wants to evaluate the impact of current regulations by going through each regulation and asking: What’s the purpose? Is this required by Congress? Is it duplicative? Does it meaningfully impact patient care and safety or improve outcomes? If not, then why do we have the regulation in the first place?
What’s more, CMS also wants to minimize burden in implementation of the Medicare Access and Chip Reauthorization Act (MACRA), as the agency said it looks to implement MACRA in a way that “minimizes the burden and costs providers face in meeting the requirements.”
“We are hearing that doctors are overwhelmed by MACRA’s new requirements and confused about the steps that they need to take,” Verma stated in her speech. “We all believe in quality and value and the move away from fee-for-service…we all believe in the need to ensure requirements aren’t burdensome…and we all believe that quality metrics need to be based on real outcomes instead of processes.”
It is expected that the 2018 final rule for MACRA’s Quality Payment Program (QPP) will be released this week. The Medical Group Management Association issued a statement supporting CMS’s “Meaningful Measures” initiative. Anders Gilberg, senior vice president, MGMA government affairs, said in a statement, “MGMA supports CMS’ efforts to reduce regulatory burdens and ensure Medicare quality measurement is meaningful and actionable for physician practices. In a recent survey of our members, (lack of) clinical relevance was ranked as the top concern under the Medicare MIPS program. We expect the 2018 QPP Final Rule (implementing MIPS and APMs) to be released this week and are hopeful these upcoming CMS regulations will be consistent with this announcement.”
In addition to focusing on quality measurement, CMS announced in September that it would be moving the Center for Medicare and Medicaid Innovation (Innovation Center) in a new direction to give providers more flexibility with new payment models and to increase healthcare competition.
In September, the agency issued a “request for information” to collect ideas on the best path forward. On the CMS Innovation Center website, CMS said the Innovation Center’s new direction will promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.
In particular, CMS says the Innovation Center is interested in testing models in the following eight focus areas—increased participation in Advanced Alternative Payment Models (APMs); consumer-directed care and market-based innovation models; physician specialty models; prescription drug models; Medicare Advantage (MA) innovation models; state-based and local innovation, including Medicaid-focused models; mental and behavioral health models; and program integrity.
Congress created the Innovation Center in 2010 to test new approaches and models to pay for and deliver health care. The Trump Administration has already taken steps to scale back some of the CMMI mandatory bundled payment programs. In August, HHS issued a proposed rule that would cancel the mandatory bundled payment programs for heart attacks and bypass surgeries as well as expansion of the existing Comprehensive Care for Joint Replacement model (CJR) to include surgical treatments for hip and femur fractures. CMS also proposed through that same rule to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, which were scheduled to begin on January 1, 2018.
Verma said the new approach to quality measurement will help address high impact measurement areas that safeguard public health. Last week, President Donald Trump directed the Department of Health and Human Services (HHS) to declare the opioid crisis a public health emergency. “So now, more than ever, we need to focus on measures around prevention and treatment for opioid addiction,” Verma said. Meaningful Measures also will help promote more focused quality measure development towards outcomes that are meaningful to patients, families and their providers, she said.
In her speech, Verma stated her support for transitioning the healthcare system away from a fee-for-service system to one that rewards value and quality, and asked for the industry’s input and innovative solutions for new payment models. “We are entering a period of high paced innovation and we need a sustainable system that moves with it,” Verma said.
“Our overall vision is to reinvent the agency to put patients first,” Verma stated. “We want to partner with patients, providers, payers and others to achieve this goal.”
