CMS, private payers play nice, agree to 7 sets of clinical quality standards
- CMS, through the Core Quality Measures Collaborative (CQMC), has released seven sets of clinical quality measures, primarily for physician quality programs.
- The CQMC is led by AHIP and its member plans’ CMOs, CMS and the National Quality Forum (NQF) members in addition to national physician organizations, employers and consumers.
- The release marks the first time multi-payer support on core measures for physician quality programs has occurred.
- "In the U.S. health care 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 work is the first of the Core Quality Measures Collaborative participants and informs the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as it lays out a development plan for quality measures, according to the press release. CMS stated the collaboration promotes alignment and harmonization of measure use and collection across payers in both the public and private sectors.
“The AAFP’s involvement in the collaborative is aimed at improving the quality of care while making family physicians’ lives easier by simplifying the information they are being asked to provide to payers.” said Douglas E. Henley, executive vice president and CEO of the American Academy of Family Physicians. “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."
Seventy percent of enrollees will be affected by the implementation of the new quality measures, according to AHIP Executive Vice President Carmella Bocchino. “The Collaborative’s efforts are a critical step forward in improving health outcomes and quality care for patients,” Bocchino said in a prepared statement. “This process will ensure measures and reporting are consistent across programs in both the private and public sectors.”
Though AHIP and CMS collaboratively launched these measures, AHIP has been confronting CMS since last year on the Medicare Advantage program and proposed payment cuts, according to several statements.
CMS stated the alignment of the seven sets will assist:
- Evidence-based measurement promotion for quality improvement;
- Consumer decision-making;
- Value-based payment and purchasing;
- Measure selection variability mitigation; and
- Decreased provider’s collection burden and cost.
The core measures are in the following seven sets:
- ACOs, patient centered medical homes, and primary care;
- HIV and Hepatitis C;
- Medical Oncology;
- Obstetrics and Gynecology; and
As the healthcare industry continues to move towards a value-based payment system, aligning payers with these measure sets help the goal to become reality.
CMS already uses most of the measures from each set but it plans on implementing all of them during their annual rule-making process and eliminate redundant measures that are not part of the core sets. Commercial health plans will use a phased-in approach when contracts come up for renewal or if they allow modification of performance measure sets.
Though CMS said consensus was reached on all measures after 18 months of collaboration, two of the Collaborative’s participants - the American College of Cardiology and the American Heart Association - said in a prepared statement that there is one decision they “strongly disagree” with “because of its potential to harm millions of patients.”
“Among these initial core measure sets are two that include measures addressing blood pressure control for patients with hypertension,” the authors wrote. “One of these measures (NQF #0018) defines adequate control as less than 140/90 mmHg; the second measure (HEDIS 2016) relaxes the target for adequate control to less than 150/90 mmHg for patients aged 60 and older without diabetes mellitus or chronic kidney disease.” These organizations are concerned with the inclusion of HEDIS 2016 as they believe it is likely for it to increase the number of patients with high blood pressure that are treated inadequately.
The collaborative plans to add more measure sets and update the current ones over time.
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