Wednesday, 17 February 2016 15:50

CMS Performance Measure Standardization: A Step in the Right Direction!

Written by Andres Jimenez, MD



There are more than 700 quality measures currently endorsed by the National Quality Forum (NQF), the nonprofit, consensus-based entity that endorsed most of the measures include in yesterday’s Centers for Medicare & Medicaid Services (CMS) statement.

For those charged with quality improvement (QI) at their organization, 700 endorsements from NQF and hundreds more endorsed by other organizations was remarkable – especially amidst increasing pressure being created by potential reimbursement penalties and perceived care gaps impacting consumer purchasing decisions. Furthermore, QI stakeholder buy-in by physicians has been restricted due to massive healthcare changes, resulting in 81 percent of physicians who are currently reporting being at or beyond capacity at work (Physician Foundation, 2014). A total of 1 in 6 physician workdays (16.6 percent) are being spent on non-patient-related administrative tasks (Woolhandler, 2014), and 46 percent of physicians recently reported feeling as though they are burned out (Medscape Physician Lifestyle Report, 2015).  So yesterday’s announcement of measure standardization marks a welcome step toward reducing provider data collection burden and increasing QI stakeholder buy-in.

The standardization was released by the Core Quality Measures Collaborative, led by America’s Health Insurance Plans, CMS, and Chief Medical Officers; it also involved national physician organizations, employers, and consumers. There were seven sets of quality measures standardized across public and private payors. These measure sets include:

  • ACO and PCMH/Primary Care (22 measures)
  • Cardiovascular (31 measures)
  • Gastroenterology (8 measures)
  • HIV/Hepatitis C Core (8 measures)
  • Medical Oncology (14 measures)
  • OB/GYN (11 measures)
  • Orthopedic (2 measures plus CAHPS Surgical Care Survey)

All measures were evidence-based, and most but not all already had been endorsed by the NQF, which served as the technical advisor for the collaborative.

So, how are thousands of measures whittled down to just (for now) a hundred? An effective measure is not only one that patients understand and value, but also one that stakeholders buy into or adopt.  Thus, measure characteristics must be known to facilitate quality improvement initiatives within a healthcare organization, and an important characteristic for stakeholder buy-in is the perceived importance of the measure.

From this perspective, measure attributes known to influence stakeholder adoption include patient benefits, feasibility within existing skill sets and resources, ease of testing, face validity, and implementation effort (Addington, et al, 2010). Creating alignment among payors subsequently should simplify the data collection and reporting process for providers. Previously, not only were providers faced with a greater number of measures due to varying payor requirements, but also, technical reporting specifications for a single measure often varied by payor, leading to significant confusion and associated expended time and costs associated with the data collection process instead of quality improvement. Thus, measure standardization is a starting point to reducing provider collection burden and costs.  

However, these costs are driven by several additional factors, most notably by the requirement to collect the right data accurately and repeatedly from today’s databases as opposed to a sea of paper charts. Although today’s data collection process is simpler than abstracting data from handwritten documentation, as most physicians can attest, a current major challenge with providing care is not a shortage of data but rather an overabundance of data –and often, this obscures the data we need, when we need it. The “where” and “how” of electronic health record (EHR) documentation not only impacts our ability to retrieve the exact information we or a colleague might need on a subsequent encounter, it can have as great an impact on patient outcomes data as the outcomes themselves. 

Every measure selected also relies on evidence-based data to validate patient benefit, which is another major driver for participation not only by providers, but by consumers of the data, patients, and those who might leverage the publicly reported data to make purchase decisions. In fact, already more than a million people use HealthgradesTM daily to research, compare providers, and connect with physicians. Not only were the measures already defined in the measure sets shown to be associated with meaningful patient outcome improvements, each measure set published by CMS suggests future measure targets, as each of the seven measure sets are expected to expand over time. For instance, in the Medical-Oncology Measure set, the following future targets related to patient benefit were identified:

  • Pain control
  • Functional status or quality of life
  • Shared decision-making
  • Appropriate use of chemotherapy
  • Under- or overtreatment
  • ER utilization

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Last modified on Wednesday, 17 February 2016 16:02