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Policy & Regulation News

New Measures Align to Simplify Health Quality Data Reporting

Collaborative participants have identified core sets of quality measures that payers have committed to using for reporting "as soon as feasible."

- Physicians stand to benefit from newly announced regulatory streamlining for reporting of quality measures, some of which require clinical data extracted from electronic health records.

Some new core quality measures require clinical data extracted from EHRs, and collection infrastructure will have to be developed.

The Core Quality Measures Collaborative — introduced on Feb. 16 by the Centers for Medicare and Medicaid Services (CMS), America’s Health Insurance Plans (AHIP) and a group of other healthcare system participants — specifies seven sets of clinical quality measures that support multi-payer alignment for physician quality programs. CMS had previously aligned quality measures across acute care hospital programs.

“Partners in the Collaborative recognize that physicians and other clinicians must currently report multiple quality measures to different entities. Measure requirements are often not aligned among payers, which has resulted in confusion and complexity for reporting providers. To address this problem, CMS, commercial plans, Medicare and Medicaid managed care plans, purchasers, physician and other care provider organizations, and consumers worked together through the Collaborative to identify core sets of quality measures that payers have committed to using for reporting as soon as feasible,” explained a statement issued by CMS.

Members of the Collaborative agreed upon core measure sets that could be harmonized across commercial and government payers. The new core measures apply to the following areas:

  • Accountable care organizations, patient-centered medical homes and primary care
  • Cardiology
  • Gastroenterology
  • HIV and hepatitis C
  • Medical oncology
  • Obstetrics and gynecology
  • Orthopedics

Several measures in the core set will be drawn from EHR data, self-reported by providers or rely on registries. A fact sheet from CMS notes: “[A] robust infrastructure to collect data on all the measures in the core set does not exist currently ... Providers and payers will need to work together to create a reporting infrastructure for such measures.”

As a result, implementation will occur in stages. CMS said it is already using measures from each of the core sets. Additionally, through the notice and public comment rulemaking process, CMS intends to implement new core measures across applicable Medicare quality programs as appropriate. The agency will also eliminate redundant measures that are not part of the core set.

Commercial health plans will implement the core sets when contracts come up for renewal, or if existing contracts allow modification of the performance measure set. Ongoing monitoring by the Collaborative will enable modification of measure sets as needed, with an eye toward minimizing unintended consequences and as new/better measures become available.

“This is a first step of an ongoing process to ensure both public programs and the private sector align measures and reporting, especially as we advance alternative payment models, said Carmella Bocchino, executive vice president of AHIP.

The American Medical Association (AMA) and American Academy of Family Physicians (AAFP) are among the doctor-centric groups participating in the Collaborative.

AMA President Steven Stack, MD, said in a public statement that the initiative “has the potential to improve the health of the nation while also reducing administrative hassle that can lead to improved professional satisfaction and sustainability of physician practices.”

AAFP CEO Douglas Henley, MD, added, “We are acutely aware of the huge amount of administrative complexity and burden that impacts the daily work of our members and diverts time and resources away from direct patient care. A major part of this is the burden of multiple performance measures in quality improvement programs with no standardization or harmonization across payers. This agreement on a set of core measures for primary care and the [patient-centered medical home] represents a big step toward the goal of administrative simplification for family physicians and improved quality of care.”



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