CMS, AHIP release first core measures for quality-based payments: 5 things to know

With an aim of improving patient care more effectively and efficiently, CMS and America's Health Insurance Plans have reached an agreement regarding core clinical quality measures for physicians across the nation.

Here are five things to know about the new measures.

1. Creating a less complicated process. CMS and AHIP released the standardized measures as part of a broad Core Quality Measures Collaborative of healthcare industry participants. Those in the collaborative recognized physicians are often required to report different quality measures to multiple payers and measures are not aligned across public and private payers. That has resulted in "confusion and complexity for reporting providers," according to CMS.

2. Promoting alignment. With the goal in mind of establishing broadly agreed-upon core measures that could be harmonized across both commercial and government payers, AHIP and its member plans' CMOs, leaders from CMS and the National Quality Forum, as well as national physician organizations, employers, consumers and patient groups worked together to develop the core measure sets. The new sets cover performance reporting in:

  • Accountable care organizations, patient-centered medical homes and primary care
  • Cardiology
  • Gastroenterology
  • HIV and hepatitis C
  • Medical oncology
  • Obstetrics and gynecology
  • Orthopedics

3. Implementing the measures. CMS said the measures will be implemented in several stages. For instance, commercial health plans will implement the core measures when contracts come up for renewal or if existing contracts allow modification of the performance measure set. CMS and partner organizations intend to add more measure sets and update the current sets over time.

4. Looking ahead. In January 2015, HHS announced its goal to shift 30 percent of all Medicare payments to value-based models by 2016. By 2018, the benchmark is to have half of all Medicare provider payments fall under an alternative model, which includes ACOs and patient-centered medical homes, among others. The standardized quality measures will aid HHS in reaching its ambitious goals.

5. This is what six industry leaders had to say about the new measure sets.

CMS Acting Administration Andy Slavitt said, "In the U.S. healthcare system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality. This agreement today will reduce unnecessary burden for physicians and accelerate the country's movement to better quality."

AHIP Executive Vice President Carmella Bocchino said establishing the core measure sets "is a first step of an ongoing process to ensure both public programs and the private sector align measures and reporting especially as we advance alternative payment models."

American Academy of Family Physicians Vice President and CEO Douglas E. Henley, MD, said, "This agreement on a set of core measures for primary care and the PCMH represents a big step toward the goal of administrative simplification for family physicians and improved quality of care."

Health Care Service Corporation Senior Vice President and CMO Stephen Ondra, MD, said, "Today's announcement by the Core Quality Measure Collaborative is an important step in getting payers, providers, purchasers and consumers on the same page when they measure and compare healthcare quality. This work will ultimately help accelerate the shift toward payment models that are based on the value of care, rather than the volume."

National Partnership for Women & Families President Debra L. Ness said, "Our healthcare system urgently needs measurement that drives improvements in quality, supports informed consumer decision-making and ensures we're paying for and incentivizing high-value care. What we released today is a start at achieving consensus on the best measures, but we need to continue pushing for even better ones."

National Quality Forum Chief Scientific Officer Helen Burstin, MD, MPH, said "The Core Quality Measures Collaborative's agreement on core measure sets for select areas of healthcare practice is an important step towards accelerating quality improvement and making healthcare more effective and efficient. Clinicians need fewer and more meaningful measures to reduce the burden of reporting similar or 'look alike' quality measures to different entities in order to free up more time for direct patient care. Equally important, this effort helps provide consumers with comparable information to better inform healthcare decisions."

More articles on quality measures:

5 specialties with the most quality-based performance measures
MAP releases annual list of 130 potential Medicare quality measures
Stakes are rising for clinical quality: How to get the metrics right

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