Advancing the EMS profession

Top News

All News

CMS and AHIP's quest to tame the wilds of healthcare quality measures

Feb 17, 2016

[Modern Healthcare]

The Obama administration and health insurers took a step Tuesday toward standardizing and improving the measures that are intended to gauge the quality of healthcare but are widely criticized as too burdensome for providers and too numerous or irrelevant to be much help to consumers.

The CMS and the trade group America's Health Insurance Plans announced an agreement to adopt a core set of quality measures for the nation's doctors. Officials say the measures are necessary as payers and consumers bear more responsibility for finding and purchasing high-quality care and providers are increasingly paid under contracts tied to their quality performance.

The agreement—which outlines seven sets of quality measures to be used across public and private payers—is the first to be announced by the Core Quality Measures Collaborative, which includes the CMS, AHIP, the American Academy of Family Physicians and the National Partnership for Women and Families. The National Quality Forum, an endorsement body for industry quality standards, was a technical adviser.

The announcement comes as industry stakeholders and policymakers struggle with how to best identify and reward high-quality healthcare. Quality metrics are increasingly tied to how much doctors and hospitals are paid. By 2018, HHS said last year, half of Medicare spending outside of managed care would be allocated under contracts with rewards and potential penalties for quality outcomes.

Experts have criticized existing quality measures as ineffective or poorly developed. Healthcare executives, meanwhile, have argued for greater standardization to avoid added costs and confusion as the federal government and various insurers develop different metrics.

The measures outlined Tuesday pertain to performance reporting from accountable care organizations, patient-centered medical homes, primary care, cardiology, gastroenterology, providers of HIV and hepatitis C care, medical oncology, orthopedics, obstetrics and gynecology.

“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,” acting CMS Administrator Andy Slavitt said in a news release. “This agreement today will reduce unnecessary burdens for physicians and accelerate the country's movement to better quality.”

Quality experts praised the push to standardize measures, which may help to arm consumers with useful information for comparison shopping and accelerate quality improvement.

Quality and consumer advocates have watched for signs that patients are using the growing amount of public performance data to choose the best doctors and hospitals, said Jessica Greene, a professor at George Washington University who was not involved in the collaborative.

“So far, however, consumers have rarely done so, in part because the measures are typically complex and described technically,” Greene said. “With one set of quality measures, we can conduct research to identify effective ways of describing the measures so that consumers understand and value them.”

Dr. Ashish Jha, a health policy and quality researcher at Harvard University, who likewise did not participate in the effort, called the move toward standardization “immensely valuable.”

“Nobody wins” when doctors spend time collecting different data for multiple insurers instead of using those resources for quality improvement, Jha said.

With an agreement to standardize measures, perhaps the industry can accelerate development of new measures that better capture what patients care about most, he said. That might a measure be how quickly a hip replacement patient returns to work after surgery. Such a measure is more difficult to develop than whether a patient returns to the hospital, but it is hugely important to patients.

“Doing what's easy is unfortunately no substitute for doing what's important,” Jha said. “Let's start doing the stuff that's important, even if it's hard.”

Consumer advocate Carol Sakala, director of childbirth connection programs at the National Partnership for Women & Families, agreed that standard measures will help consumers make comparisons and new measures are needed to address gaps in quality reporting.

She called the collaborative a good start and said measure development must continue. More work must be done to fill gaps such as measures of care coordination, shared decisions between patients and doctors, and performance on outcomes reported by patients themselves, Sakala said.

The number and type of quality metrics used varies across health insurers and technical specifications can vary even for the same measure, said Dr. Douglas Henley, executive vice president and CEO American Academy of Family Physicians. “You can just see the level of complexity and confusion that creates,” Henley said.

Variation across health plans can appear arbitrary, as is the case with slight differences in insurance company measures for well-managed blood pressure or blood sugar, said Dr. Robert Wergin, a rural family practice physician at the Milford (Neb.) Family Medical Center, which is owned by the 15-bed Memorial Health Care in nearby Seward, Neb.

Wergin, the current chair of the AAFP, said the agreement to standardize core measures would reduce the confusion. He runs his small clinic with a physician assistant and an office manager. “I don't mind being measured, but it's really hard to be measured on 88 or 132 quality measures,” he said. “Simplification is a good thing.”

Participants in the collaborative said the measures will continue to evolve.

"The AMA looks forward to continuing to participate in this initiative dedicated to alignment of quality measures because it has the potential to improve the health of the nation while also reducing administrative hassle that can lead to improved professional satisfaction and sustainability of physician practices," Dr. Steven Stack, president of the American Medical Association, said in a news release.

The CMS will adopt the newly identified measures that aren't already included in the agency's metrics, and will eliminate those not included in the agreement. Private payers will include the collaborative measures in their contract agreements.

The collaborative, formed in 2014, included payers that accounted for 70% of health plan and Medicare enrollees who were not covered by Medicare managed care as of July 2015. Although national insurers Aetna and UnitedHealth Group have since left the AHIP, they remain in the collaborative, said Carmella Bocchino, executive vice president of America's Health Insurance Plans.