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The 57th American Society of Hematology (ASH) Annual Meeting & Exposition

Experts Share Concepts of Quality Measures and Pay-for-Performance at the Annual ASH Meeting

Surabhi Dangi-Garimella, PhD
At the annual meeting of the American Society of Hematology, providers brooded over implications of quality measures and how they will influence clinical practice in the coming years.
Quality measurement, public performance reporting, and pay-for-performance have rapidly translated into established processes in the delivery, assessment, and evaluation of medical care in the United States, accelerated by the Affordable Care Act and CMS’ proposed transition to value-based reimbursement. On the first day of the annual meeting and exposition of the American Society of Hematology, held December 5-8, 2015, in Orlando, Florida, experts discussed these measures and what they’d mean for a practicing hematologist in the coming years.

Some of the questions that were explored in this session included:
  • Are current quality programs heading in the right direction?
  • Can quality measures really help physicians improve patient care?
  • Are quality measures ever more harmful than helpful? Does pay-for-performance work?
Helen Burstin, MD, MPH, from The National Quality Forum (NQF), during her talk, Quality Measures, Quality Reporting, and Value-Based Remuneration: How Did We Get Here and Where Are We Going?,  said, “As we move toward the new world of value-based payments, we really need to understand how did we get here and where are we going with these measures?”

The federal government, Burstin explained, came up with a National Quality Strategy, the premise for which is better care, healthier people and communities, and smarter spending. These were national priorities that were laid out.

“The push to population health in communities is a big area that needs prioritizing. The move from volume to value is a sea change, and there’s significant growth expected in the move from fee-for-service (FFS) linked to quality payments and alternative payment models. By 2018, we expect 50% adoption of alternate payment models and 90% FFS-quality link is expected,” said Burstin.
The question remains, though, whether we have the tools to bring about this change and whether we are ready for this move.

There are of course challenges to be surmounted, including tensions in measurement, according to Burstin, which include:
  • While outcomes measures are included to deduce accountability, process measures are primarily used for quality improvement.
  • The measurement burden for providers and clinicians creates the need for developing more comprehensive measures.
  • While the need is primarily for system-level measurements, individual clinician-level measurements are being set by the Medicare Access & CHIP Reauthorization Act of 2015.
  • Limited set of core measures (need metrics to meet needs of each specialty)
As we plan to move away from process-based to outcomes-based measures, there’s a need to think of modifying processes that can improve outcomes. A major move in the healthcare field, Burstin said, is the incorporation of patient-reported outcomes (PROs) into quality measures. “But these measures are riddled with challenges—they are not widely used in practice, more-so in clinical trials,” and we don’t have a method yet to aggregate PROs, she added.

Burstin listed the following challenges commonly faced when utilizing these measurements:
  • Persistent measurement gaps
  • Potential for unintended consequences
  • Alignment and harmonization of measures
  • Complex measurement science issues
Outcomes measure themselves have their limitations, said Burstin, including, but not limited to:
  • Patient selection can lead to differences across physician or hospital population (risk adjustment)
  • Small sample size or event rate
  • Longer term outcomes may be difficult to track
  • Ideal outcomes may not be achievable

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