CMS' 3-Year Update on Quality Measures Finds Progress, But Important Gaps Remain

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Under the Affordable Care Act, CMS is charged with evaluating how well accepted quality measures are working to help meet a National Quality Strategy.

Overlooked in the tousle over whether subsidies for low-income Americans survive or whether Medicaid expands in red states are other parts of the Affordable Care Act (ACA): those elements that seek to make healthcare better, safer, and more in line with what patients and families want.

CMS reported on one of those pieces late Monday when it issued a required 3-year update on how well it is doing with implementing a National Quality Strategy (NQS); specifically, it issued a report to assess how well agreed-upon quality measures across a variety of areas are doing to improve patient care.

The “2015 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report,” sounds like a government report and it reads like one, too. While it contains important information on how far the needle has moved in just a few years, a review of the executive summary reveals just how far the healthcare system must go to deliver something close to what the ACA promised.


Bright spots are patient safety and overall improvement in clinical care; a key finding says 95% of 119 publicly reported measure rates across 7 quality reporting programs showed improvement during the study period of 2006 to 2012. Areas that made the most progress are process measures—which measure whether staff took certain actions—as opposed to outcomes measures, which rate how the well patients did. The report called for eliminating those process measures that do not connect directly to patient outcomes.

Less encouraging is the finding that of the 6 main domains that are NQS priorities (promoting safety, patient and family engagement, coordination of care, promoting preventive treatment, working with communities to promote best practices, and affordable care), the domains where measures were most underrepresented were affordable care and care coordination. Yet, care coordination is widely recognized as an essential element in improving health outcomes for those patients who account for the greatest costs to the system: those with multiple chronic conditions, including those with behavioral health issues.

The summary also points out the lack of alignment between federal measures and those in state programs. “State Medicaid and state hospital report cards are more closely aligned than measures developed by the Veterans Health Administration,” the summary states. “Analyses of the measures used by some state programs and the VHA showed that over half of the measures are locally developed measures.”

On the plus side, CMS found that race and ethnicity disparities narrowed significantly between 2006 and 2012, although they persist across many programs. Disparities improved the most for Hispanics, African Americans and Asians; those that exist for Native Americans, Alaska Natives and Native Hawaiian/Pacific Islanders improved the least.

Overall, the report called for a greater focus on measures tied to patient outcomes, greater use of data sources, and an exploration of a third-party validation process. Also worth considering: Studying the providers who have found a way to deliver good patient outcomes at an affordable cost. Both qualitative and quantitative studies should be pursued, the report said, to gain a richer understanding of how this combination is achieved.

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2015 National Impact Assessement Report