How to accurately and fairly measure health care providers

January 19, 2012

In keeping with its mandate to inform the public of the measures it’s considering for adoption, the Centers for Medicare & Medicaid Services (CMS) has compiled a list of 367 new ideas on how to accurately and fairly measure doctors, hospitals and other health care providers. The proposed measures came from a variety of sources, including the CMS, CDC, industry groups, companies, health care organizations, universities, research groups and others. After a thorough review, CMS is expected to adopt about 60 of the measures.

A key goal of the Patient Protection and Affordable Care Act (ACA) is to shift reimbursements from being based on the quantity of services delivered to being based on improved efficiency, lower costs and improved quality of care provided. These new measures will be assessed and selected based on their ability to help CMS in their efforts to achieve this goal.

In addition, the ACA requires a federal “pre-rulemaking process” for selecting quality and efficiency measures. In compliance with this requirement, CMS submitted the entire list of proposed measure to the NFQ organization Measures Application Partnership (MAP) for their review.  MAP has studied the proposed measures to determine which ones it believes will accurately and fairly measure health care provider performance.” Their pre-rulemaking report is posted online and indicates which measures it does and does not endorse.

The new measures under consideration for 2012 are spread across 12 out of 23 CMS programs. In the chart below (from the CMS list of measures) you’ll find the number of measures being considered listed by program. It’s interesting to note that most of the measures are concentrated into just a few of the programs.

  • 153 measures (more than 40%) fall under the CMS program Physician Quality Reporting System
  • Other programs with many new measures include Medicare and Medicaid Incentive Program for both eligible professionals and for Hospitals and CAHs, and Hospital Inpatient Quality Reporting
  • None of the measures are related to the Medicare Shared Savings Program, Health Insurance Exchange Quality Reporting, or Medicare Part C and Part D Plan Rating Programs.
CMS Program

No. of new measures

End Stage Renal Disease Quality Improvement

5

Hospice Quality Reporting

6

Hospital Inpatient Quality Reporting

22

Hospital Value-Based Purchasing

13

Inpatient Psychiatric Facility Quality Reporting

6

Inpatient Rehabilitation Facility Quality Reporting

8

Long-Term Care Hospital Quality Reporting

8

Medicare and Medicaid EHR Incentive Program for Eligible Professionals

92

Medicare and Medicaid EHR Incentive Program for Hospitals and CAHs

39

Physician Quality Reporting System

153

Prospective Payment System (PPS) Exempt Cancer Hospital Quality Reporting

5

Physician Feedback/Value-Based Modifier Program: Value-Based Payment Modifier

10

Sources:

http://capsules.kaiserhealthnews.org/index.php/2012/01/measuring-quality-368-new-ideas-for-2012/

http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69495

http://www.cms.gov/QualityMeasures/15_MultiStakeHolderGroupInput.asp

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