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CMS releases 2015 Quality Measures Report
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CMS released the 2015 National Impact Assessment of Quality Measures Report, demonstrating that the nation has made significant progress in improving the health care delivery system to achieve better care, smarter spending and healthier people, the agency announced in a blog post.
“This report is a comprehensive assessment of quality measures used by CMS,” Patrick Conway, MD, deputy administrator for innovation and quality, and chief medical officer at CMS, wrote in the blog. “It examines the effectiveness and impact of measurement and demonstrates our commitment to achieving optimal results from our quality measurement programs.”
Key findings
In the report, CMS summarizes key findings from quality measurement efforts. Specifically, 95% of the 119 publicly reported performance rates across seven quality reporting programs showed improvement from 2006 to 2012. Moreover, about 35% of the 119 measures were classified as “high performing,” which means performance rates above 90% were achieved in each of the most recent 3 years for which data were available, according to the blog. Improvements were also observed in racial and ethnic disparities from 2006 to 2012.
Conway reported between 7,000 and 10,000 lives were saved through improved performance on inpatient hospital HF process measures from 2006 to 2012. In addition, 4,000 to 7,000 infections were avoided through improved performance on inpatient hospital surgical process measures, he wrote.
Next steps
“Quality measurement is a key lever that CMS uses to drive the transformation of the health care system in partnership with hospitals, clinicians, and patients,” Conway wrote. “We will use the results from the 2015 Impact Report to refine our CMS quality measurement strategies, better understand the measures that have worked well and guide the development and application of measures going forward.”
Conway said new themes and actions have emerged, therefore providing new insights for informed measure and program-specific decisions in the months ahead.
“We hope providers, private payers and patient communities will use this report to understand which measures have worked well and which have had less of an impact on quality,” he wrote.
Medicare payment increases
In another blog post, the CMS announced nearly 7,000 physicians across 14 U.S. group practices will receive an increase in their Medicare payments in 2015 as part of the Value-based Payment Modifier of the Affordable Care Act if they provide evidence of high quality care.
“The CMS posted results from the implementation of the first year of the Value-based Payment Modifier (Value Modifier). Part of the Affordable Care Act, the Value Modifier rewards physicians and groups of physicians who provide high-quality and cost-effective care, while encouraging improvement for those who do not report quality measures or who do not meet the mark,” Conway and Sean Cavanaugh, deputy administrator and director of CMS, wrote in the blog.
The physician groups who met performance requirements in 2013 had lower hospital readmission rates — 14.3 per 100 admissions vs. 16.4 per 100 admissions for the corresponding benchmark.
Eligibility
During 2015, the Value Modifier will be phased in gradually and applied to physician groups with 100 or more eligible professionals. The CMS will focus on three main areas:
- improvements in the way providers are paid;
- improvements in care delivery; and
- broader sharing of information to providers, consumers and others in order to support better decisions while maintaining privacy.
Quality tiering
Groups had the choice of electing in or out of quality tiering — a voluntary option during year 1 of the Value Modifier. Quality tiering determines an upward, downward or neutral type of payment adjustment as well as the amount of the adjustment, according to the blog. For 2015 alone, groups that chose not to elect quality tiering will not be subjected to upward or downward adjustments.
Group practices that receive increases fall into two categories: those that provide high-quality care and have average costs compared to national benchmarks, which comprises the majority of those receiving increases, and those that were determined to lower costs and met average quality performance vs. national benchmarks.
However, beginning in 2016, all physician groups will fall under quality tiering. These groups include those with at least 10 or more eligible professionals. In 2017, the modifier will apply to all physician groups and solo practitioners.
“Although the Value Modifier currently only applies to physician payments, beginning in 2018, CMS will begin applying it to non-physician eligible professionals as well,” they wrote. “When it comes to improving the way providers are paid, we want to reward value and high-quality care, rather than volume. The Value Modifier reinforces our emphasis on quality, value and shared accountability, and recognizes and rewards those physician groups and physicians who meet those goals.”
References:
Quality Measurement Impact Reports