First set of clinical quality measures from CMS, AHIP aim to standardize, simplify

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With an eye toward standardization, the Centers for Medicare & Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) have released  seven sets of clinical quality measures.

These measures support multi-payer alignment, for the first time, on core measures primarily for physician quality programs, according to the announcement posted by CMS. This work is informing CMS’ implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) through its measure development plan and required rulemaking, and is part of CMS’ commitment to ensuring programs work for providers while keeping the focus on improved quality of care for patients.

Physicians and other clinicians must currently report multiple quality measures to different entities and measurement requirements often are not aligned among payers, which has resulted in confusion and complexity for reporting providers. To address this problem, CMS, commercial plans, Medicare and Medicaid managed care plans, purchasers, physician and other care provider organizations and consumers worked collaboratively to identify core sets of quality measures that payers have committed to using for reporting as soon as feasible.

This release is the first from the collaborative, which plans to add more measure sets and update the current measure sets over time. CMS and the partner organizations believe that by reducing the complexity for providers and focusing quality improvement on key areas across payers, quality of care can be improved for patients more effectively and efficiently.

“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.”

The guiding principles used by the collaborative in developing the core measure sets are that they be meaningful to patients, consumers, and physicians, while reducing variability in measure selection, collection burden, and cost. The goal is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers.

 The core measures are in the following seven sets:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs), and Primary Care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics

“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, MD, AAFP executive vice president and CEO of the American Academy of Family Physicians. “We are acutely aware of the huge amount of administrative complexity and burden that impacts the daily work of our members and diverts time and resources away from direct patient care. A major part of this is the burden of multiple performance measures in quality improvement programs with no standardization or harmonization across payers. 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.”

Implementation of the measures will occur in several stages. The collaborative will continue to convene to monitor progress, invite broader participation and add additional measures and measure sets.

“Members of the Collaborative have taken a leadership role in identifying measures that will drive quality improvement and outcomes for patients,” said Carmella Bocchino, AHIP executive vice president. “This 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.”