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Analysis

EHR Official: Positive Changes Proposed for Quality Measures

By Christopher Cheney  
   July 24, 2018

The AMGA's proposed 14-metric measurement set and proposed changes to Medicare's quality measures draw largely favorable reviews.

Recently proposed quality measure changes are generally steps in the right direction, an Electronic Health Record Association official says.

A pair of quality measure changes were proposed this month. The Centers for Medicare & Medicaid Services (CMS) have proposed changes as part of the Medicare Physician Fee Schedule for 2019, and the American Medical Group Association (AMGA) has proposed a 14-metric measurement set.

The proposed CMS changes would alter measures in the Quality Payment Program, which features the Merit-based Incentive Payment System (MIPS) and advanced alternative payment models. The proposed changes to MIPS are modest, says Ida Mantashi, chair of the Electronic Health Record Association's Quality Measurement Workgroup.

"I was surprised that the measure changes were not huge. The measures that have been proposed for removal are not that highly used—we were expecting some of them to go away," she says.

The CMS proposals include eliminating MIPS process-based quality measures that clinicians have called low-value or low-priority, according to CMS. The proposed changes to MIPS are designed to elevate the importance of measures that have a more significant effect on health outcomes, CMS says.

Mantashi applauded CMS for maintaining quality measures for specialty practices. "Some specialties have so many little measurements that they can't go to fixed measures. … I hope CMS never gets rid of the measure functionality for the specialty practices."

Evaluating AMGA measures
 

The AMGA, which is based in Arlington, Virginia, has proposed quality measures that are designed to reflect value in care and to lessen administrative burden.

The AMGA measurement set features both process measures such as cancer screening and outcome measures such as hospital readmission rates:

  • Emergency department use per 1,000
     
  • Skilled nursing facility admissions per 1,000
     
  • 30-day all cause hospital readmission
     
  • Admissions for acute ambulatory sensitive conditions composite
     
  • HbA1C poor control
     
  • Depression screening
     
  • Diabetes eye exam
     
  • High blood pressure control
     
  • CAHPS, health status, and functional status
     
  • Breast cancer screening
     
  • Colorectal cancer screening
     
  • Cervical cancer screening
     
  • Pneumonia vaccination rate
     
  • Pediatric well-child visits through age 15 months
     

In general, Mantashi gives the AMGA measurement set a positive review.

"They did a good job putting this list together. It is not an easy task to account for all of the directions and needs in healthcare. They have done a good job of bringing everything under the same umbrella," she says.

However, the AMGA measurement set is a poor fit for many specialty practices, says Mantashi, director of product management at Boca Raton, Florida-based Modernizing Medicine.

"The problem with 14 measures is that if you are in a specialty, you are going to have a very hard time reporting all 14. For example, dermatologists don't have readmissions."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


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