Measure Applications Partnership: eCQMs Are Valuable But Still Need Work
The Measure Application Partnership, which provides recommendations on the selection of performance measures for federal health programs, has highlighted the importance of digital quality measurement, but suggested that many electronic clinical quality measures (eCQMs) are not entirely ready for use in accountability programs.
MAP, a multistakeholder group convened and facilitated by the National Quality Forum (NQF), provides a coordinated look across federal programs at performance measures being considered and makes recommendations to the Centers for Medicare & Medicaid Services (CMS).
Measure burden and digital measures
The CMS Quality Measurement Action Plan includes a focus on the transition to digital quality measures as a way to reduce measurement burden. MAP noted that eCQMs give opportunities for real-time feedback to providers, but stressed that many are not ready to be put in use. “Electronic health record (EHR) vendors should be engaged throughout the process to ensure that such measures are ready for deployment,” the report noted. MAP also emphasized the need to ensure that digital quality measures are transparent to all entities, including health plans.
In addition, MAP underscored the need for mitigating measurement burden and recognized that the use of eCQMs and other digital quality measures could reduce data collection and reporting burden. MAP emphasized deeper alignment between public and private payers to have identical core measures as a potential means to decrease measurement costs and burden. MAP added that this needs to be balanced with pockets for measurement innovation to allow the quality measurement enterprise to move forward.
MAP said that there is some resistance to patient-reported outcome performance measures (PRO-PMs) because they are seen as more burdensome to collect. MAP encouraged CMS to provide support and infrastructure to ease the burden of data collection for PRO-PMs.
Connections between cost measures, quality measures
MAP said it recognized that CMS is required by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 to implement cost measures within the MIPS program. However, MAP expressed concerns related to explicit connections between cost and quality for measures that CMS is considering for MIPS: “While the need to use appropriately correlated cost and quality measures together to assess health system efficiency is well established, there is currently no clear consensus among stakeholders or recognized state of the art on precisely how to do so. NQF has built much of its work around cost and resource use measurement on guidance established by prior work, including the Institute of Medicine’s definition of efficiency and NQF’s Patient Focused Episode of Care Model. In 2014, an NQF white paper explored various approaches to deploying cost and quality measures concurrently.”
MAP noted that cost measures carry implicit concern associated with care stinting. It further asserted that the best initial clinical intervention for a patient may result in higher episode-based costs although long-term global cost savings may eventually be realized. This also dictates a need for clear connections to upstream interventions that result in downstream cost savings.
MAP encouraged CMS to focus on cost measures that are fair to providers in appropriately connecting quality care and cost savings that demonstrate true value-based care. MAP suggested that there are opportunities to perform further analysis, especially for episode-based cost measures that focus on chronic conditions to establish the impact measures have on quality of care.
