News Feature | February 26, 2016

CMS Releases Seven Sets Of Standards For Clinical Quality

Christine Kern

By Christine Kern, contributing writer

clinical trials

Agreement assures multi-payer agreement on quality measures.

An agreement has been reached between CMS and America’s Health insurance Plans (AHIP) to support a set of clinical quality measures that will facilitate multi-payer agreement on core measures of medical care for the first time.The CQMC is led by AHIP and its member plans’ CMOs, CMS and the National Quality Forum (NQF) members in addition to national physician organizations, employers and consumers.

Through the Core Quality Measures Collaborative (CQMC), CMS has released seven sets of clinical quality measures, primarily for physician quality programs.These measures support the CMS implementation of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and CMS reports the move is part of its commitment to ensuring programs work for providers while not losing sight of improved quality of patient care.

“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 CMS statement noted, “There is a great demand today for accurate, useful information on healthcare quality that can inform the decisions of consumers, employers, physicians and other clinicians, and policymakers. This is increasingly important as the healthcare system moves towards value-based reimbursement models.”

Part of the challenge is the fact that healthcare providers must report multiple quality measure to different entities, measures that are often not aligned among payers and result in confusion for reporting providers. These new standards aim to reduce the complexity and confusion surrounding quality standards.

“Members of the Collaborative have taken a leadership role in identifying measures that will drive quality improvement and outcomes for patients,” said Carmella Bocchino, Executive Vice President, America’s Health Insurance Plans. “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.”

Designed to be meaningful to patients, consumers, and physicians, the alignment of these core measure sets will aid in:

  • promotion of measurement that is evidence-based and generates valuable information for quality improvement
  • consumer decision-making
  • value-based payment and purchasing
  • reduction in the variability in measure selection
  • decreased provider’s collection burden and cost

The core measures are in the following seven sets:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), 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, Executive Vice President and Chief Executive Officer 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.”