CMS, Private Payers Agree on Physician Quality Measures

Added on Mar 21, 2016

CMS, Private Payers Agree on Physician Quality Measures
From Industry Edge March 2016

In an effort to align quality standards across commercial payers and the Centers for Medicare & Medicaid Services (CMS), ease the reporting burden on physicians and improve patient care, the Core Quality Measures Collaborative (CQMC) — which comprises representatives of CMS, America’s Health Insurance Plans (AHIP), national physicians’ organizations, employers and patient groups — has released seven sets of clinical quality measures that will cover 70% of commercial payer enrollees.

Currently, there is no standard reporting model, so physicians have to report different metrics to each insurer, adding to the paperwork they face and making it difficult to reliably assess overall performance. Further, the various measures frequently overlap, meaning physicians often have to report multiple measures that assess the same thing, because each insurer has its own metric.

Over a period of 18 months, the collaborative gathered feedback from stakeholder groups and reviewed current CMS and other health plans’ metrics, as well as those recommended by the National Quality Forum (NQF), before reaching consensus on the seven sets of core metrics that cover the following categories:

The measures, which primarily focus on physician quality programs, are the first to support multipayer alignment, according to CMS. More measures will be added, and the current measures will be updated over time.

The Health Care Payment Learning and Action Network, a public-private collaboration established by CMS, will integrate the quality measures into its efforts to align payment models with public and private-sector partners. Furthermore, CMS is working with the Office of Personnel Management, the Department of Defense, the Department of Veterans Affairs and state Medicaid plans to align quality measures where appropriate. The CQMC plans to continue to monitor the use of these measures and make modifications where necessary.

It is important to note that some of these measures are not widely collected and some are not yet part of a CMS program. CMS will introduce new measures or measure requirements through its normal rulemaking cycle.