How to measure quality

Medicare’s Shared Savings Program (MSSP) contracts with accountable care organizations (ACOs) and provides financial rewards to ACOs that provide high-quality, low-cost care.  One question is whether or not the MSSP program does a good job of defining quality.

A paper by Valuck and co-authors examines what constitutes high-quality of care for 20 high-cost and highly prevalent diseases.  The authors use quality of care recommendations from medical specialty societies and patient advocacy groups.  They find the following:

We found measure gaps across all 20 conditions, including those conditions that are commonly addressed in current measure sets. In addition, we found many gaps that could not be filled by existing measures…

Addressing all gaps in accountable care measure sets with more of the same types of measures and approaches to measurement would require an impractical number of measures and would miss the opportunity to use better measures and innovative approaches. Strategies for effectively filling measure gaps include using preferred measure types such as cross-cutting, outcome, and patient-reported measures

As the authors note, increasing the number of measures to better measure quality must be offset by the additional complexity and reporting buden of adding more measures to the ACO program. Quality measurement is a good thing, but as CMS transitions more and more to value-based purchasing, they may need to wonder whether tying 90% of reimbursement to value-based metrics is too much of a good thing.



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