Core Quality Metrics Announced

The Center for Medicare and Medicaid Services (CMS) released the first set of “Core Quality Measures”  this Tuesday, in which CMS and private payers agree to utilize in value-based payments. The collaborative includes members from America’s Health Insurance Plans (AHIP), as well as both Aetna and UnitedHealth Group. This initial set of metrics includes a comprehensive clinical comparison in the following categories:

  1. Accountable Care Organizations, Patient-Centered Medical Homes, and Primary Care
  2. Cardiology
  3. Gastroenterology
  4. HIV and Hepatitis C
  5. Medical Oncology
  6. Obstetrics and Gynecology
  7. Orthopedics

These standardized metrics aim to assist patients, physicians, employers, and payers in:

  • Promoting of evidence-based Quality Improvement
  • Consumer Decision-Making Processes
  • Value-Based Contracting, Purchasing, and Reimbursement
  • Reducing Variance
  • Decreasing Redundant Reporting Burdens

The collaborative agrees not to include only these metrics in Value-Based contracts as current contracts expire, they also introduce future metrics to be included, and only after considering open comments.  CMS Acting Administrator Andy Slavitt pledges “patients and care providers deserve a uniform approach to measure quality,” aligning with Harold D. Miller’s critique on the potential impact of “Implementing Alternative Payment Models Under MACRA.”

This step represents a major transition towards simplifying the burden of redundant measurement that adds little value to the patient, a shift heavily encouraged by Dr. Don Berwick, President Emeritus of The Institute for Healthcare Improvement. Though wary professionals recognize unintended consequences are often plentiful in transitional periods, it is important to recognizeCMS is aggressively pursuing Quality Standardization in both Advanced Payment Models (APMs) and Merit-Based Incentive Payment System (MIPS).  As healthcare providers continue operating on a FFS basis above the surface, it is unquestionably vital to monitor the “simplification process,” virtually all major payers are embarking on.

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