The new standards for CMS Quality Measure Reporting (MACRA)- A brief introduction


CMS sets a universal format for Physician Quality Measures

There is no doubt that physician quality measures are necessary. But for the longest time, physicians have had to deal with many types and formats of quality measures that the private insurance payers and public used to assess clinical performance of healthcare providers. Now the trend of using multiple quality measurement sets are coming to an end.

The Centers for Medicare and Medicaid Services (CMS) and almost all major health insurance plans, in combination with various medical organizations, employer and consumer groups have just announced the first set of “core measures” that will be used for value based payments.

Several health insurers including members of America’s Health Insurance Plans (AHIP), as well as United Health Group and Aetna have just released a joint collaborative listing seven key core measure sets including metrics for the following specialties:

CMS Quality Measure Reporting

  • Accountable care organizations
  • Cardiology
  • Gastroenterology
  • HIV and hepatitis C
  • Medical oncology
  • Obstetrics and gynecology
  • Orthopedics
  • Patient-centered medical homes (PCMHs)
  • Primary care

With time, this collaborative will continue to add  additional measure sets and update the current sets over time. CMS has already stated that it has already started to use these measures from each of the core sets. After ensuring the appropriate rules, CMS will put into practice new core measures across applicable Medicare quality programs. It hopes to get rid of all unnecessary and outdated measures that are not part of the core sets.

In addition, CMS will also oversee the Office of Personnel Management, Department of Defense, and the Department of Veterans Affairs to ensure that their quality measures align with these core sets.

Commercial health plans will start to apply these measure sets when hospital or healthcare contracts come up for renewal. So far it is not known if all AHIP member plans will implement the new core measures.

CMS Acting Administrator Andy Slavitt reminded everyone that “In the U.S. healthcare system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality. This agreement today will reduce unnecessary burden for physicians and accelerate the country’s movement to better quality.”

The news release stated that the collaborative work “is informing CMS’s implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).”

metrainer_blog_content_macra__0MACRA will establish at a later date on how physicians will be paid by Medicare starting in 2019. Meanwhile, quality data presently being reported to the Physician Quality Reporting System is being used as the basis for CMS’ value-based modifier, which will affect all physicians’ Medicare income, starting 2017.

Physicians have long been concerned about the high degree of complexity and burden of reporting on quality measures. There have been numerous complaints in the past from healthcare providers that this endeavor has been taking time and resource from direct patient care. The chief reason for this was the multiple performance measures with little standardization across payers. Hopefully, this new agreement on a set of core measures for primary care and PCMH will be a big step forward in improving the quality of care.