CMS, payers release core quality measures for physicians

February 24, 2016

Collaborative aims to reduce metrics burden

Physicians may finally get some relief from the growing array of quality metrics they have had to contend with in recent years.

The Centers for Medicare & Medicaid Services (CMS) announced last week that it and America’s Health Insurance Plans (AHIP) have developed a core set of clinical quality measures for use in:

 

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  • Accountable care organizations, patient-centered medical homes and primary care,

  • Cardiology,

  • Gastroenterology,

  • HIV and hepatitis C,

  • Medical oncology,

  • Obstetrics and gynecology, and

  • Orthopedics

 

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The announcement is an outgrowth of the Core Quality Measures Collaborative, a joint initiative that includes CMS, AHIP (the trade association representing most large commercial payers), the National Quality Forum, physicians’ organizations and others to align and harmonize quality measures used by both public and commercial payers.

Next: Physicians react

 

The collaborative was formed in part to address complaints from physicians about providers’ growing use of metrics to evaluate-and sometimes compensate-providers in their networks. Doctors say the lack of overlap among measures forces them to spend a great deal of time tracking each payer’s measures and documenting that they have met them.

 

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A 2013 report by the healthcare consulting firm Bailit Health Purchasing LLC looked at 48 state and regional “measure sets”–such as the measures used by commercial payers for patient-centered medical home certification-and found a total of 1,367 individual measures. Moreover, Bailit found very little overlap, with only 20% of measures used in more than one such measure set.

Wayne J. Riley, MD, MACP, president of the American College of Physicians (ACP), in a statement posted on the ACP’s website, called development of the core measure sets “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.”

 

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“Just making sense of dozens, if not hundreds of different performance measures requires investing time and effort that would be better spent on actually improving patient care,” Mark Friedberg, MD, MPP, a senior natural scientist with the Rand Corporation, told Medical Economics in an e-mail. “So having a more coordinated and parsimonious core measure set is a good thing.”

Next: What will the future look like?

 

 “We think this agreement will lead to better care and less administrative complexity,” says Douglas Henley, MD, FAAFP, president of the American Academy of Family Physicians (AAFP). “The average family practitioner has to deal with seven payers, each with its own set of quality measures. It inhibits better quality care and it takes time away from treating patients.” The AAFP and ACP are participants in the Core Quality Measures Collaborative. 

 

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The full text of the CMS announcement is available here.

For more on physician frustration with quality metrics, see the cover story in the March 10 issue of Medical Economics.