The Centers for Medicare & Medicaid Services and America’s Health Insurance Plans on Feb 16 announced a set of core quality measures across seven areas that will serve as the foundation for a more uniform set of quality metrics that will be used by both public and private payers.
The CMS and AHIP are working with the National Quality Forum, medical specialty societies, employer groups, and consumer groups under an umbrella organization called the Core Quality Measures Collaborative. Together, they derived a set of measures that are “meaningful to patients, consumers, and physicians, while reducing variability in measure selection, collection burden, and cost,” the CMS noted in a fact sheet .
Involved medical specialty societies include the American Academy of Family Physicians, American College of Cardiology, American Heart Association, American College of Physicians, American Gastroenterological Association, HIV Medicine Association, Infectious Diseases Society of America, American Academy of Pediatrics, American Society of Clinical Oncology, and the American Medical Association.
The collaborative announced core measures in seven areas: accountable care organizations/patient centered medical homes/primary care , cardiology , gastroenterology , HIV and hepatitis C , medical oncology , obstetrics and gynecology, and orthopedics . Measures in additional areas will be released in the future and the core sets will be reviewed and updated on a regular basis.
“I think [this collaboration] strikes the best balance between what is feasible and what is desirable,” Dr. Ziad Gellad, chair of the AGA Quality Measures Committee , said in an interview.
For Medicare, Medicaid, and other public programs, the measure sets will be implemented and updated through the physician fee schedule in the coming Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). Private payers are expected to begin implementing these quality measures as physician contracts come up for renewal.
“I think one of the biggest challenges will be how to collect these measures, because the decision about what measures to include was only driven in part by the feasibility,” Dr. Gellad said. “A large part was driven by what are the best metrics and what are most important outcomes and processes to evaluate. I think in terms of feasibility, that is going to be the next important question. How do you improve the feasibility of these measurements in practice?”
Electronic health records will play an integral part, as a FAQ released by AHIP notes that several of the measures “require that clinical data be extracted from EHRs or registries or be self-reported by clinicians.” It adds that clinicians and payers “will need to work together to create a reporting infrastructure for such measures” in areas where it is currently lacking.