New Quality Metrics to be Developed for Physicians and Hospitals

Quality Measures

The Centers for Medicare and Medicaid Services (CMS) and the trade group America’s Health Insurance Plans (AHIPs) have agreed to adopt a core set of quality measures for doctors.

Here’s a lowdown on all you need to know about the new agreement and its impact.

Who’s in on it?

The agreement will be implemented by the Core Quality Measures Collaborative which includes CMS, AHIP, the American Academy of Family Physicians and the National Partnership for Women and Families. The National Quality Forum acts as a technical adviser.

Why are New Quality Measures needed?

The initiative is aimed at improving and standardizing the currently burdensome quality measures that exist. Identifying and rewarding high-quality healthcare is difficult under the current measures, which is especially problematic as quality metrics are tied to how much doctors and hospitals are paid.

Healthcare executives have been wanting greater standardization to reduce added costs and confusion due to different metrics from the federal government and insurers. For small practices, being measured on more than a 100 quality measures can be expensive in more ways than one.

At the same time, there is no discernible movement among consumers towards high quality doctors and hospitals because quality measures are technical and complex. The number and type of quality metrics vary across insurers and technical specifications vary even in the same measure. Also, existing quality measures aren’t necessarily considered important or relevant by customers.

Proposed Benefits of the New Measures

The measures will reduce unnecessary burden on physicians. The new measures will also be able to address existing gaps in quality reporting such as measures of care coordination, shared decisions between patients and doctors, performance on outcomes reported by patients.

They will also provide consumers with useful information for comparison shopping and accelerate quality improvement in ways that are easier for them to understand. The measures also aim to include metrics and information that is perceived as relevant by patients and customers.

Who are they applicable to?

The agreement will have seven sets of quality measures applicable to public and private players. They will require performance reporting from accountable care organizations (ACOs), patient-centered medical homes, primary care, gastroenterology, HIV and Hep C care providers, cardiology, medical oncology, orthopedics and Ob Gyn.

More standardized measures can potentially improve the overall health of the nation, however, it remains to be seen just how effective these measures will be in the healthcare industry.

For more of the latest information and expert guidance on the healthcare industry, check out our section on healthcare compliance.


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