Government, payers working to streamline quality measures

May 10, 2016

In the average medical practice, the burden on physicians to meet differing quality measurement standards set by payers is substantial. Commercial health plans, the Centers for Medicare & Medicaid Services (CMS) and state Medicaid managed care plans all have different metrics for evaluating quality care.

Joseph BurnsIn the average medical practice, the burden on physicians to meet differing quality measurement standards set by payers is substantial. Commercial health plans, the Centers for Medicare & Medicaid Services (CMS) and state Medicaid managed care plans all have different metrics for evaluating quality care.

“On average, family physicians have to report their performance on quality measures to seven different payers,” says Kate Goodrich, MD, MHS, director of the Center for Clinical Standards and Quality at CMS. 

Now CMS is seeking to ease that burden by identifying quality measures for seven specific areas or clinical conditions, and it intends to incorporate those measures into regulations it will propose under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. MACRA calls for CMS to establish new systems for rewarding physicians for delivering quality care. 

At CMS, Goodrich oversees implementation of much of the MACRA legislation, including the Merit-Based Incentive Payment System (MIPS). In this role, she plans to combine CMS’ existing quality reporting programs, such as the Physician Quality Report System (PQRS), into one new system, she says. In addition, she plans to remove duplicate measures.

“If you’re a doctor reporting on 35 to 40 different measures, you can’t focus your quality improvement because those efforts are too diffuse,” says Goodrich, who still works one weekend per month as a hospitalist. 

In February, CMS and America’s Health Insurance Plans (AHIP), the trade association for commercial health insurers, identified quality measures for physicians in primary care (including those in accountable care organizations and patient-centered medical homes), cardiology, gastroenterology, doctors serving patients with HIV and hepatitis C, medical oncology, obstetrics and gynecology and orthopedics.

 

Designed to improve and simplify quality reporting among clinicians and public and private payers, the measures will make it easier for health insurers and clinicians to promote population health and coordinate care more efficiently, says Clare Krusing, AHIP’s director of communications. 

Health plans will begin implementing the measures as contracts renew or are modified. CMS is already using these measures and will implement new core measures and eliminate redundant measures as needed.

Shari Erickson, MPH, vice president of governmental affairs and medical practice for the American College of Physicians (ACP), is optimistic about the new quality measures but also is concerned that they don’t go far enough. On March 1, ACP sent a 42-page letter to CMS containing more than 30 recommendations. 

Among ACP’s suggestions is using  MACRA to build a learning healthcare system, as the Institute of Medicine (now the National Academy of Medicine) recommended in 2011. New payment systems being designed under MACRA should incorporate lessons from past quality measurement efforts and allow for innovation. “We hope these additional recommendations will make the quality measures from AHIP and CMS even better over the long term,” Erickson says.

The new measures are the result of efforts over the past two years by AHIP, CMS, the National Quality Forum and organizations representing physicians, patients, and others to identify useful measures to reduce the burden, costs, and variability inherent in requiring physicians to meet multiple measurement standards, CMS says. 

AHIP expects to continue working with CMS to develop new measures, improve the ones issued this year, and incorporate lessons learned from science and evidence-based medicine, Krusing says.