CMS, America's Health Insurance Plans set unified healthcare quality measures
This is the first set that will be used as basis for quality-based payments, CMS says.
For the first time, the Centers for Medicare and Medicaid Services and America's Health Insurance Plans have announced standard quality measures among payers, a move designed to reduce confusion and complexity for reporting providers.
On Tuesday, CMS and AHIP released seven sets of clinical quality measures to help get insurers on the same page. This is the first set that will be used as basis for quality-based payments.
They were developed by a Core Quality Measures Collaborative, made up of CMS, major commercial health plans, physician groups and other stakeholders.
These measures create a set of core standards for all payers primarily for physician quality programs. They are in the following seven sets: 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 measures will be rolled out in several stages, said CMS, which is already using measures from each of the core sets.
CMS also said it will apply the core measures to Medicare quality programs, eliminating repetitive measures.
Partners in the collaborative recognized that physicians and other clinicians must currently report multiple quality measures to different entities, CMS said.
CMS worked with commercial plans, Medicare and Medicaid managed care plans, purchasers, physicians and other care provider organizations, as well as consumers to identify core sets of quality measures that payers have committed to using for reporting.
The Core Quality Measures Collaborative, led by AHIP and its member plans' chief medical officers, leaders from CMS and the National Quality Forum, established the broadly agreed upon core measure sets that could be used for both commercial and government payers.
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More measure sets will be added and updated over time.
"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," said CMS Acting Administrator Andy Slavitt. "This agreement today will reduce unnecessary burden for physicians and accelerate the country's movement to better quality."
"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," said Douglas E. Henley, MD, executive vice president and CEO of the American Academy of Family Physicians.
Commercial health plans will use these core sets of measures when contracts come up for renewal, or if existing contracts allow changes in the performance measure set.
CMS is also working with federal partners including the Office of Personnel Management, Department of Defense, and Department of Veterans Affairs, as well as state Medicaid plans to align quality measures where appropriate.
The Core Quality Measures Collaborative views the upcoming year as a transitional period, as it begins to work with the new measures and affected organizations. They plan to monitor progress, invite broader participation, and possibly add additional measures and measure sets.
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Patient groups were a vital part of the collaborative.
"What we released today is a start at achieving consensus on the best measures, but we need to continue pushing for even better ones," said Debra L. Ness, president of the National Partnership for Women & Families. "We need measurement that works for clinicians and helps them improve care, while also providing information that is meaningful and actionable for patients and families."
This work will influence CMS's implementation of the Medicare Access and CHIP Reauthorization Act of 2015. It is part of CMS's commitment to ensuring programs work for providers while keeping the focus on improved quality of care for patients, CMS said.
CMS has also developed a draft Quality Measure Development plan, fueled by the development of the core measure sets as well as the discovery of gaps in the measures.
Twitter: @SusanJMorse
