Seven measure sets aim to alleviate the burden and cost of measuring clinical quality and will "support multi-payer alignment, for the first time, on core measures primarily for physician quality programs," says CMS.
Responding to complaints of excessive, conflicting, and meaningless quality reporting requirements, the Centers for Medicare & Medicaid Services and representatives of the private insurance industry have agreed to use a single set of healthcare quality measures.
CMS says that the measures "support multi-payer alignment, for the first time, on core measures primarily for physician quality programs."
CMS acting administrator Andy Slavitt and Carmella Bocchino of America's Health Insurance Plans announced the seven "core measures" on a teleconference Tuesday.
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Andy Slavitt |
Slavitt acknowledged there is a consensus on the need for quality measures. The push for quality, however, has translated into an array of confusing and sometime overlapping measurement and reporting requirements "often adding to physician burden and weakening the signal of the importance of quality," he said. "Everywhere you go in healthcare, people universally ask for one thing: simplify, simplify, simplify."
CMS is already using many of the core measures and will add new measures "as appropriate while eliminating redundant measures," Slavitt said. The goal is to get private plans to phase the new measures into new and renewed contracts.
The group behind the effort called the Core Quality Measures Collaborative consists of purchasers, providers, and consumers. Also at the announcement: Douglas E. Henley, MD, of American Academy of Family Physicians representing providers, and Carol Sakala, National Partnership for Women & Families, who spoke for consumers. Stephen Ondra represented the Health Care Service Corporation, which is affiliated with Blue Cross and Blue Shield.
Bocchino, of AHIP, said that the effort underscores the importance of partnerships and called it "a major step forward for alignment of quality measures."
The group said the collaborative represents 70% of all healthcare payers, including Aetna and UnitedHealth Group. (Those two insurers are no longer AHIP members, having left in 2015. AHIP is trying to get them to rejoin the powerful lobbying organization.)
Commercial payers have agreed to begin using the measures "as soon as feasible," according to the CMS announcement.
According to CMS: "The guiding principles used by the Collaborative in developing the core measure sets are that they be meaningful to patients, consumers, and physicians, while reducing variability in measure selection, collection burden, and cost. The goal is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers."
7 Measure Sets
The groups looked at quality review efforts at CMS and private insurers, as well as those endorsed by National Quality Forum, and came up with seven "measure sets" for
- Primary care, accountable care organizations, and patient-centered medical homes
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
Members of the group agree on a number of concerns, including the need to monitor the use and efficacy of the measures. "We are going to continue to track how these measures are adopted and where changes need to be made as medical evidence changes and new measure become available," Bocchino said.
The collaborative must work with payers to ensure they adopt the measures in their quality improvement programs, Henley noted. "Absent this, our efforts with be for naught," he said. "The current chaotic and administratively burdensome requirements of these programs will continue if we are not successful, and true patient-centered care will not be realized."
Sakala said the effort will benefit consumers because it will encourage doctors and providers to focus on high-value care. She said there are now numerous poorly aligned measurement programs that don't consider important variables. The measures should provide meaningful and actionable information so consumers can make wise decisions, Sakala said: "When we ask them to devote precious resources to measurement, it will be for measures that matter."
Patrick Conway, MD, chief medical officer for CMS, said the new measures will be rolled into the new Merit-Based Incentive Payment System (MIPS) program, which goes into effect in 2019. CMS is working on a Quality Measure Development Plan (MDP) as part of the MIPS program and currently has a draft plan up for public comments until March, with plans for a final plan to be in place by May.
Conway said he's had experience with reporting quality measures when he was a clinician.
"It can create a challenge if the measures are not aligned. This is a major and truly historic effort at public and a private payer quality measure alignment," he said.
Reaction
The American College of Physicians expressed its support for the Collaborative in a statement released Tuesday, calling the effort " a major step forward to reduce variability in measure selection, specifications, and implementation. It sets a model for future work on performance measurement alignment in these and other areas."
Blair Childs, Premier, Inc. senior vice president of public affairs was more guarded. In a statement issued by his office Tuesday afternoon, he called the plan to issue a consistent set of quality measures "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."