CMS: Quality measure changes coming this year

Providers should expect to see some concrete action taken soon on reducing the burden of quality reporting, according to a CMS presentation on the agency’s “Meaningful Measures” initiative at the HIMSS18 conference in Las Vegas.

The goal of the initiative, first announced in October 2017, was to move away from process-focused measures to outcome-based metrics, reduce the volume of quality reporting overall and streamline measures across various CMS programs, all so physicians can spend more time with patients. One sign of the program shifting CMS priorities was seen in its December 2017 Measures Under Consideration list, which contained only 32 measures, down from 97 the year before, though there was only a small increase in its share of outcomes-based measures.

The agency has also been collecting industry comments on how it can reduce the reporting burden, such as the suggestions offered by the American Medical Group Association (AMGA). Providers should soon start to see some of their suggestions out into action when CMS begins releasing its proposed payment rules for 2019.

“You’ll start to see some changes in our regulations this year,” said CMS chief medical officer Kate Goodrich, MD, MHS, “related to Meaningful Use but a lot of other areas as well.”

Goodrich said they’ve already taken some smaller steps in this direction based on listening sessions or visits to different facilities. One example is the recent change removing the requirement for physicians to redocument entries into electronic health records made by medical students, which Goodrich said illustrates the agency’s commitment to minimizing the reporting burden on providers.

Pierre Yong, MD, MPH, MS, the director of the Quality Measurement & Value-Based Incentive Groups at CMS, went deeper into the goals of Meaningful Measures in his portion of the HIMSS18 presentation. Measures should be focused on “bigger concepts,” he said, not the “little blue dots” which may have been the focus of the gradual layering of quality reporting programs on top of each other.

Yong broke the initiative down into six Meaningful Measure areas with examples of worthwhile measures in each category:

• Healthcare-Associated Infections (with measures like surgical site infections)
• Patient Functional Status (such as Functional Status Assessment for Total Hip Replacement)
• Medication Management (such as Use of High Risk Medications in the Elderly)
• Prevention and Treatment of Opioid and Substance Use Disorders (such as Alcohol Use Screening)
• Equity of Care (such as Discharge to Community-Post Acute Care)
• Appropriate Use of Healthcare (such as Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis)

The initiative will not replace any existing CMS programs, create new requirements or mandate new measures, Yong said, though the work will identify “gaps in available quality measures” along with aligning measures across the agency’s models. While one of the priorities has been to reduce the number of process-focused measures, “high-priority” process measures will be considered in areas where outcomes measures may not be possible.

“We’ve started to evaluate those measures against this framework, where we’ve gone measure by measure and looked at them in detail and tried to think about whether they meet the goals of this initiative,” Yong said.

Yong did emphasize that quality reporting wasn’t going away—even if reporting on any measure may be seen as a burden and providers argue it could lead them to avoid high-risk patients who may adversely affect their scores.