CMS announces new push to reduce process-focused quality measures

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 - CMS Administrator Seema Verma, MPH
CMS Administrator Seema Verma, MPH

CMS Administrator Seema Verma, MPH, said the agency is launching a new initiative called “Meaningful Measures” aimed at focusing quality reporting on outcome-based measures, rather than processes.

In a speech at the Health Care Payment Learning and Action Network (LAN) Fall Summit in Arlington, Virginia, Verma said the agency is still dedicated to value-based care, but “how we define value and quality today is a problem.” Current standards which involve family medicine physicians reporting 30 measures to seven payers or require hospital staff to manually enter information on 12 of the 61 hospital inpatient measures are contributing to physician burnout, she said, without significant benefits to patients.

“Until we get to a smaller set of more impactful measures that assess outcomes rather than processes, the burden associated with reporting measures will run the risk of outweighing their intended purpose,” Verma said. “We understand the problem, we understand the frustration, and we understand that something needs to be done.”

The initiative will seek to revise current quality measures to “ensure that measure sets are streamlined, outcomes-based, and meaningful to doctors and patients.” It also include an re-examination of the overall star ratings for hospitals, which had already been delayed under Verma’s leadership while groups like the American Hospital Association has called on the ratings to be suspended over “flawed methodology.”

Reducing process-focused measures has informed the agency’s implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), Verma said. Calling MACRA’s initial quality measure requirements “more boxes to check,” she said the agency will seek to make the program less of a burden on physicians by making a slow transition to its new requirements.

“We all believe in quality and value and the move away from fee-for-service,” she said. “We all believe in the need to ensure requirements aren’t burdensome and we all believe that quality metrics need to be based on real outcomes instead of processes.”

The reasoning behind the initiative falls in line with other CMS policies under the administration of President Donald Trump. In recent months, the agency has sought to address concerns about overregulation and administrative burden by proposing more clinicians be exempt from MACRA and cancelling mandatory bundled payment programs.

Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), praised the new initiative, saying “lack of clinical relevance” is the chief complaint its members about regulations surrounding MACRA’s Merit-based Incentive Payment System (MIPS).

“We expect the 2018 (Quality Payment Program) final rule (implementing MIPS and APMs) to be released this week and are hopeful these upcoming CMS regulations will be consistent with this announcement,” Gilberg said in a statement to HealthExec.