P4P Quality

Core Quality Measures

One challenge providers have faced in the past is that quality measure reporting has been complex.  Medicare may ask for quality measures with one definition, commercial payers may define quality a second way, and Medicaid may ask for a third definition of quality.  Keeping track of these definitions and recording quality measures distracts providers from actually providing quality care to their patients.

With this issue in mind, CMS and a trade organization known as America’s Health Insurance Plans (AHIP) have create seven sets of core measures that public and private payers will use in a consistent measures.  As AJMC reports, there are  7 sets of core quality measures.   The seven sets of core measures fall into the following groups:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics

Why is this coordination needed?  A CMS statement says:

“In the U.S. Health care system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality,” said CMS Acting Administrator Andy Slavitt. “This agreement today will reduce unnecessary burden for physicians and accelerate the country’s movement to better quality.”

Centralizing quality measures has the advantage of simplifying quality reporting for providers.  However, CMS and AHIP will need to approve changes to these core measures.  As new medical techniques and treatments become available, will the core measures be flexible to adapt to changing practice patterns?  My guess is ‘no’.  Thus, CMS should carefully consider how best to track quality while maintaining flexibility to adjust the definition of “quality” based on how the state of the science evolves over time.

1 Comment

  1. Oh yeah! I trust ANYTHING put out by AHIP. How stupid are we? Come on people!

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