Medicare P4P Quality

Which Medicare initiatives use quality measures?

In December, CMS listed its quality measures that it is considering for incorporation into some of their value-based payment programs and quality reporting programs. However, which Medicare quality reporting and payment initiatives use quality measures?  A full list is below.

  1. Ambulatory Surgical Center Quality Reporting Program (ASCQR)
  2. End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
  3. Home Health Quality Reporting Program (HH QRP)
  4. Hospice Quality Reporting Program (HQRP)
  5. Hospital-Acquired Condition Reduction Program (HACRP)
  6. Hospital Inpatient Quality Reporting Program (HIQR)
  7. Hospital Outpatient Quality Reporting Program (HOQR)
  8. Hospital Readmissions Reduction Program (HRRP)
  9. Hospital Value-Based Purchasing Program (HVBP)
  10.  Inpatient Psychiatric Facility Quality Reporting Program (IPFQR)
  11.  Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP)
  12.  Long-Term Care Hospital Quality Reporting Program (LTCH QRP)
  13.  Medicare and Medicaid EHR Incentive Program for Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs)
  14. Medicare Shared Savings Program (MSSP)
  15. Merit-based Incentive Payment System (MIPS)
  16. Prospective Payment System (PPS)-Exempt Cancer Hospital Quality Reporting Program (PCHQR)
  17. Skilled Nursing Facility Quality Reporting Program (SNF QRP)
  18. Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP)

One can readily see how these quality-based programs, while well-intentioned could be problematic for providers.   A hospital that is part of an ACO that provides inpatient, outpatient and psychiatric and rehabilitatoin facilities would be subject to quality reporting for HACRP, HIQR, HOQR, HRRP, HVBP, IPFQR, IRF QRP, and MSSP.  That is a lot of quality reporting.

Another question you may have are whether these measures are any good.  Most measures are NQF endorsed.  Further, a number of other of government agencies have provided input on these measures.  A full list of agencies providing input is below.

  1. Office of the Assistant Secretary for Health (OASH)
  2. Office of the National Coordinator for Health Information Technology (ONC)
  3. National Institutes of Health (NIH)
  4. Agency for Healthcare Research and Quality (AHRQ)
  5. Health Resources and Services Administration (HRSA)
  6. Centers for Disease Control and Prevention (CDC)
  7. Substance Abuse and Mental Health Services Administration (SAMHSA)
  8. Office of the Assistant Secretary for Planning and Evaluation (ASPE)
  9. Indian Health Service (IHS)

In short, getting from volume to value-based payment, ultimately depends on being able to accurately measure quality.  Measuring quality is a lot easier to do in theory than in practice.


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