Quality Measures Will Rule the Day…Are You Ready?

It’s no secret that healthcare providers are increasingly paid to deliver higher-quality healthcare at lower costs. New delivery and payment models such as accountable care organizations provide healthcare to millions and are all the “buzz” in our industry. But a lesser known and more sweeping reform in healthcare payments is on the horizon.

In 2013, the federal government started rolling out the value-based payment modifier to the Medicare physician fee schedule. Soon every healthcare practitioner will have their Medicare payments adjusted based on the cost and quality of healthcare they deliver.

Yes, people. Pay for performance is finally here and it will forever change your market.

In 2014, organizations of a 100 or more healthcare professionals were required to report their 2013 calendar year performance on a set of Clinical Quality Measures (CQMs). If they failed to report, they received an automatic 1% negative payment adjustment.

Next year the reporting requirements expand to every organization with at least 10 healthcare professionals. This comes down to just about every customer you care about. Trust me. Check your target list.

The requirement to report CQMs is just the beginning. Quality tiering under the value-based payment modifier will begin in 2016. Starting in 2016, Medicare payments will be subject to upward, neutral or downward adjustments of up to 2% based upon performance toward cost and quality measures. Eventually, payment adjustments will range from a 5% bonus to a penalty resulting in a 5% decrease.

Think about that for a moment. Most of your customer’s Medicare payments will be at risk of a -5% adjustment based upon their cost and quality performance. Do you think this might change things a bit?

What Your Customers Will Report

What do your customers need to report? The reporting requirements are managed through the Physician Quality Reporting System (PQRS). Healthcare organizations will be required to choose a set of CQMs based upon criteria such as care setting and types of care typically provided. For example, the General Practice/Family Practice Preferred Specialty Measure Set includes 44 measures for which an FP or GP needs to choose to report at least nine measures.

What The Reports Means to Marketers

What does this mean for you? Roughly one-third of the average healthcare provider’s revenue will be at risk for a 5% penalty. Your customers will therefore be hyper-focused on the health conditions for which they are measured. As the number of measures they are required to report increase, they will only be able to focus on the health conditions for which they are measured.

If your products support one of the measured health conditions you will be highly relevant to your customers. Use that to your advantage. Understand the details of the CQMs and reporting requirements. Design marketing programs that support appropriate use of your product and help your customer’s efficiently and effectively meet their quality measure requirements.


  • Craig Kemp

    Craig Kemp, Innovative Partnerships at Merck Vaccines, has 22 years of experience in healthcare marketing. He’s an accomplished copywriter and specializes in all aspects of the physician “buy and bill” commercial model.


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