Evolving CMS Quality Measures Move Towards More Patient-Centered Care, Less Burden for Clinicians

Though developed to ensure that health systems deliver effective, safe, efficient, patient-centered, equitable, and timely care, CMS clinical quality measures don’t always match organizational, clinician, and patient interests and priorities. Quality measures, however, remain critical as health systems continue to build strategies and processes around value-based payment.

Today, CMS is increasingly aligning measures with health system goals. Organizations can now empower themselves around regulatory requirements, turning measures into an opportunity for improvement, and no longer a burden.

CMS is listening to health system concerns with focus in key areas:

  • How quality measures can hinder optimal patient care.
  • Moving towards value with existing barriers and existing fee-for-service (FFS) incentives.
  • Changing the reimbursement infrastructure to curtail the industry’s upward spending trajectory.

Under the current approach, health systems that work with CMS and communicate their quality-reporting challenges and goals have an opportunity to help move themselves and the healthcare industry more effectively towards value-based care.

Today’s Quality Measures Prioritize Patient Care

The CMS comprehensive Meaningful Measures initiative identifies high-priority areas for quality measurement and improvement. The framework aims to improve outcomes for patients, their families, and health systems while also reducing burden on clinicians and providers.

To qualify as meaningful under the CMS criteria, measures must help move payment toward value by focusing the healthcare industry on the same quality areas. Meaningful Measures must meet certain criteria:

  • Are patient-centered and meaningful to patients, clinicians, and providers.
  • Address high-impact measure areas that safeguard public health.
  • Are outcome-based where possible.
  • Minimize the level of burden for providers.
  • Create significant opportunity for improvement.
  • Address measure needs for population-based payment through alternative payment models.
  • Align across programs.

Targeting High-Impact Areas for Quality Measurement and Improvement

Under the Meaningful Measures Initiative, CMS has identified high-impact areas for quality measurement and improvement. Meaningful Measures quality categories and their 19 corresponding areas are available on the CMS website.

The Meaningful Measures Framework (Figure 1) places the patient at the center of CMS strategic goals, with customer experience, flexibility in state and local leadership, innovation, and patient empowerment as the strategic goals. The framework aims to give health systems and payers more granular details about measurement areas, offer a leaner and more patient-centric approach to developing and implementing meaningful quality measures, and reduce the burden of quality reporting on clinicians and providers.

meaningful measuresFigure 1: The Meaningful Measures Initiative (CMS. Accessed January 2019.)

Reducing Regulatory Burden

The Patients Over Paperwork initiative solidifies the CMS commitment to putting patients first and reducing unnecessary regulatory burdens on clinicians (allowing them to spend more time with patients). An important aim of Patients Over Paperwork is to “de-duplicate” certain measures that occur in multiple programs. The initiative keeps the measures in the programs where they can best incentivize improvement.

This will mean removal of 18 measures and de-duplication of 25. For example, under a proposed 2019 rule change to the inpatient prospective payment system (IPPS), when incentives appear around the same event (e.g., CLABSI or CAUTI) in several programs, CMS will limit incentives to only the most necessary programs so the clinicians aren’t reporting the same event multiple times.

The initiative gives health systems an internal process to evaluate and streamline regulations, increase efficiencies, and improve the patient experience. Meaningful Measures are part of the Patients Over Paperwork; other steps include simplifying office visit documentation, mapping the nursing home experience, reducing burden through coding and documentation reform, and other key barriers to optimal care. 

Three Tools to Empower Health Systems Around Evolving Regulatory Measures

CMS has designed the Meaningful Measures initiative to better support patients, health systems, and clinicians. To get the most from the changes under the Meaningful Measures initiative—optimal reimbursement—health systems need data- and analytics-driven tools to best understand measures and make sure they’re integrated with the overall quality landscape.

Tools that strengthen executive decision support, population health review, and benchmarking, for example, can help organizations (and their patients and clinicians) thrive as regulatory measures evolve:

1. Executive Decision Support

A new-generation executive decision support tool, such as Health Catalyst® Leading WiselyÔ, can help health systems orient their teams around the same quality topics to minimize additional burden and drive care. Using personalized watch-lists, configurable visualizations, and customizable alerts and notifications, Leading Wisely gives organizations one source (versus multiple systems) to view key measures and goals to strategize, balance, and optimize performance.

2. Population Health Review

Another Health Catalyst tool, the Community Care Advanced Application caters to primary care clinical program leaders, primary care providers and care coordinators in ambulatory settings, quality improvement teams, and staff responsible for reports related to the organization’s status as an ACO. Community Care gives organizations data for activities to review population health:

  • Compare their performance to national benchmarking standards for specific measures.
  • Identify opportunities for costs savings.
  • Track, monitor, and meet the needs of high-risk patients.

3. Benchmarking

Health systems can use a next-generation benchmarking tool (e.g., Health Catalyst Touchstone™) to understand events that factor heavily in CMS measures, including readmissions and mortality. Touchstone is an AI-enabled tool that shows organizations where they’re performing well and where than can improve along the continuum of care.

Health systems can empower themselves by assessing how their strategic plans align not only with CMS measures but also with external ranking reports. There are many programs and an abundance of quality measures, making it increasingly important to prioritize measures that improve quality of care and resist the distractions of variable metric definitions as each new report comes out. Tools that enable healthcare leaders to track their own performance will find fewer surprises in external reports and, ultimately, continue working toward system improvement.

Transforming Compulsory Measures to Empower Health Systems, Patients, and Clinicians

Quality measures don’t need to make healthcare organizations feel powerless. By using data and analytics to find efficiencies in how they structure quality measures strategies and aligning strategic goals, health systems can improve experiences for their patients and clinicians while delivering higher quality, more cost-effective care.

With Meaningful Measures, CMS is clearly listening to health system and clinician concerns and making sure its guidelines and requirements are meaningful to all involved in healthcare delivery, most notably the patient. With increasingly patient- and clinician-centered initiatives, CMS has made concrete efforts to respond to industry needs and concerns; healthcare organizations that take this invitation to strategize around the increasingly patient-centered CMS approach are most likely to thrive in the evolving regulatory landscape.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

  1. Five Strategies for Easing the Burden of Clinical Quality Measures
  2. The 7 Best Ways to Prepare for MACRA Today
  3. Are Health Systems Ready for MACRA? Survey Reveals the Number One MACRA Concern and Varying Degrees of Readiness
  4. The Who, What, and How of Health Outcome Measures
  5. Clinically Meaningful Quality Metrics Improve the Provider Experience
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