Quality Reporting is not Just for CMS

February 6th, 2017 - Wyn Staheli
Categories:   MIPS|PQRS|PQRI  
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With the shift in healthcare to value-based payment systems (e.g, Merit-based Incentive Payment System (MIPS)), providers need to be aware of individual payer requirements and be prepared to report quality measures for all. A group called "The Collaborative" which includes CMS, America's Health Insurance Plan, physician groups and other interested stakeholders, have released standardized quality measures intended to streamline provider reporting.

Quality measures are good in that they can help to improve our national health care standards by:

  • preventing overuse, underuse and misuse of services
  • identifying what works and what doesn't and pushing for better outcomes
  • holding payers and providers accountable for providing high-quality care
  • identifying problem areas so that solutions can be found
  • allowing consumers to make better informed health care decisions.

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 created additional funding with the intent to create and implement new measures where gaps exist and align CMS measures with the private sector. As required under MACRA, CMS announced the final version of their Quality Measure Development Plan in May of 2016.

The new Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) payment systems for Medicare are the first steps towards this new approach and other private payers have indicated that they will be taking a phased-in approach as provider contracts come up for renewal. 

MIPS identifies the following types of measures and activities as part of its payment system:

  1. Quality
  2. Improvement activities
  3. Advancing Care Information
  4. Cost

The National Quality Measures Clearinghouse is a public resource for quality measures and the group that maintains the HHS measures sets. Their clinical quality measures are organized into the following groups:

  • Access - did the patient receive timely and appropriate healthcare?
  • Structure - what types of facilities, personnel or policies are related to the delivery of the patient care?
  • Process - was the service provided consistent with established care standards?
  • Outcome - what is the result of the patient care received?
  • Patient experience - how does the patient feel about the care provided?

Note that there may be some differences between quality measures required between payers, but steps are being taken to ensure that providers can decrease the administrative burden of reporting quality measures.


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