physician quality

Simpler physician quality measures on the way

As Medicare, Medicaid and commercial payers have shifted toward alternative payment models in recent years, their varying standards for judging value have been a headache for healthcare providers. Outcomes that one payer deemed acceptable may not have passed the bar for another payer—resulting in confusion and increased administrative time for providers.

That will likely change, however, thanks to a new agreement reached by the Core Quality Measures Collaborative (CQMC)—a group made up of representatives of CMS, America’s Health Insurance Programs (AHIP), national physician organizations, employers and patient groups. The Collaborative recently announced that it has developed a standardized model for measuring physician quality, which it projects will be implemented in the coming years by both CMS and commercial payers.

While more “measure sets” will be standardized over time, the initial quality measures cover:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs), and Primary Care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics

Andy Slavitt, the acting director of CMS, stated the new measure sets “will reduce unnecessary burden for physicians and accelerate the country’s movement to better quality.” As a researcher from Harvard University told Modern Healthcare, “Nobody wins when doctors spend time collecting different data for multiple insurers instead of using those resources for quality improvement.”

Supporters of the standardization also point out that it will make it easier for patients to compare and choose doctors. On that front, the CQMC has additional plans—its next step will focus on making quality measures even more patient-friendly by including patient-reported outcomes on factors like recovery time from surgery.

“Patients and care providers deserve a uniform approach to measure quality,” said Slavitt in a CMS statement. Many in the industry are hopeful that the CQMC’s work will be a major step toward that goal.