CMS sets a universal format for Physician Quality Measures

There is no doubt that physician quality measures are necessary to meet the growing need for data to support progress being made in patient outcomes and “quantified healthcare”. Physicians have been inundated with various types and formats of quality measurement metrics that are different for similar procedures and treatments.

This course is intended for use by individuals involved in the design and/or conducts human subject research and prepares investigators involved in the design and/or conduct of research involving human subjects to understand their obligations to protect the rights and welfare of subjects in research. The course material presents basic concepts, principles, and issues related to the protection of research participants. Private and public payers are using clinical data to determine contract and reimbursement rates. In fact, Medicare intends on using up to 90% of quality indicators as a basis for determining fee-for-service payment by the year 2018. This has created a serious need to come to a consensus on which quality indicators will be used to measure patient care.

The Centers for Medicare and Medicaid Services (CMS) and almost all major health insurance plans, in combination with various medical organizations, employer and consumer group

s have just announced the first set of “core measures” that will be used for value based payments.

Several health insurers including members of America's Health Insurance Plans (AHIP), as well as United Health Group and Aetna have just released a joint collaborative listing seven key core measure sets including metrics for the following specialties:

• Accountable care organizations
• Cardiology
• Gastroenterology
• HIV and hepatitis C
• Medical oncology
• Obstetrics and gynecology
• Orthopedics
• Patient-centered medical homes (PCMHs)
• Primary care

With time, this collaborative will continue to add and update the measurement metrics over time. CMS has already stated that it has already started to use these measures from each of the core sets. After ensuring the appropriate rules, CMS will put into practice new core measures across applicable Medicare quality programs. It hopes to eliminate all unnecessary and outdated measures that are not part of the core sets.  In addition, CMS will also oversee the Office of Personnel Management, Department of Defense, and the Department of Veterans Affairs to ensure that their quality measures align with these core sets.

Commercial health plans will start to apply these measure sets when hospital or healthcare contracts come up for renewal. So far it is not known if all AHIP member plans will implement the new core measures. CMS Acting Administrator Andy Slavitt reminded everyone that "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."

The news release stated that the collaborative work "is informing CMS's implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)."

MACRA will establish at a later date on how physicians will be paid by Medicare starting in 2019. Meanwhile, quality data presently being reported to the Physician Quality Reporting System is being used as the basis for CMS' value-based modifier, which will affect all physicians' Medicare income, starting 2017.

Physicians have long been concerned about the high degree of complexity and burden of reporting on quality measures. There have been numerous complaints in the past from healthcare providers that this endeavor has been taking time and resource away from direct patient care. Hopefully, this new agreement on a set of core measures for primary care and PCMH will be a big step forward in standardizing performance measures, while simultaneously contributing to improving the quality of care.