After Years of Research Into Dissatisfaction With Quality Measures, Is CMS Listening?

Allison Inserro

Last week, CMS announced its “Meaningful Measures” initiative, seeking to streamline quality and cost measures. The sheer number of quality measures have soared over the last decade, and CMS said that part of its reasoning is to reduce the burden of quality reporting on healthcare providers so they can spend more time with patients. The new measures also seek to quantify healthcare outcomes.

CMS posted the Measures under Consideration (MUC) Lists for 2018 pre-rulemaking, and has sent it to the National Quality Forum (NQF) in preparation for multi-stakeholder input. CMS is seeking stakeholder input and is accepting comments through today, December 7, on the National Quality Forum website. The website also lists the stakeholder meetings, which are open to the public.

The list contains 32 measures (down from 184 originally submitted by stakeholders) that could improve quality in clinician practices, hospitals, and dialysis facilities. The measures also aim to track effectiveness, safety, and patient-centeredness of the care provided. 

Approximately 40% of measures on the list are outcome measures, including patient-reported outcome measures—an effort to empower patients make their own healthcare decisions and to assist clinicians with continuous care improvements.

In addition, this year there are 8 episode-based cost measures proposed.

The burden of reporting such measures have long been noted to increase the stress on healthcare providers­. Recent reports, such as 2015’s Vital Signs: Core Metrics for Health and Health Care Progress from the National Academies for example, have all documented that quality measures, while necessary, need to be simplified, refined, and made meaningful in order to be clinically relevant. 

Having an abundance of quality measures­, required by government and private payers, can drive down physician engagement, as clinicians see all that data-collecting as busy work that takes time away from patient care.

In 2016, a study in Health Affairs found that US physician practices in 4 common specialties (cardiology, orthopedics, primary care, and multispecialty practices) spend 785 hours per physician and more than $15.4 billion to report quality measures. The study emphasized the need for better and standardized measures to bring down the cost of reporting quality measures. The authors noted that “the current system is far from being efficient and contributes to negative physician attitudes toward quality measures.”

"On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study is that nearly three-fourths of the groups reported that the quality measures are not even clinically relevant,” Halee Fischer-Wright, president and CEO of the Medical Group Management Association, said in a statement when the study was released.

One payer said this week any move to streamline administrative burdens is a good one, and that next year they are looking to ensure that the metrics used for each disease are the most clinically meaningful and lead to real change in health outcomes.

“Anything that simplifies the administrative burden for the physician offices, particularly those smaller practices with limited infrastructure is helpful, and appreciated by the physicians,” said Thomas Graf, MD, vice president and chief medical officer, Horizon Blue Cross Blue Shield of New Jersey, in a statement to The American Journal of Managed Care®.

“Consolidating on clinically important metrics that are routinely measured in the process of delivering care is a far more important way to impact this,” Graf said. He explained that Horizon leverages it’s Healthsphere private network, HIE, to pull clinical measures directly from the electronic health records of their provider partners. “Today we report on nearly 20 chronic diseases and wellness in an all-or-none fashion, updated in real-time to improve the health status of our members/patients,” a process he described as being effortless—beyond clinical care delivery on the part of the physicians—but with promise to deliver significant administrative relief.

References

Institute of Medicine; Committee on Core Metrics for Better Health at Lower Cost; Vital Signs: Core metrics for health and health care progress. Washington, D.C.: National Academies Press; Published April 2015. Accessed December 7, 2017.

Casalino L,  Gans D,  Weber R, et al. US physician practices spend more than $15.4 billion annually to report quality measures. Health Aff. 2016; 35(3):401-406. doi: 10.1377/hlthaff.2015.1258.
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