Responding to criticism from healthcare institutions that quality measures have become too numerous and diverse, CMS is adopting a core set of quality measures with the intention of standardizing data collection and making it more meaningful. But will this change have much effect on hospitals?
CMS worked with the Core Quality Measures Collaborative, a group of professional organizations and insurers, to develop seven core sets of quality measures that the groups say will support greater quality improvement and reporting across the health system. Core measure sets were developed for the following practice areas:
- accountable care organizations (ACOs)/patient-centered medical homes (PCMH)/primary care;
- cardiology;
- gastroenterology;
- HIV/Hepatitis C;
- medical oncology;
- obstetrics and gynecology;
- orthopedics.
The collaborative’s members say the measures are necessary as payers and consumers bear more responsibility for finding and purchasing high-quality care and providers are increasingly paid under contracts tied to their quality performance. The seven core measures are the first to be announced by the collaborative, which includes CMS, America’s Health Insurance Providers, the American College of Cardiology, the American Heart Association, the American Academy of Family Physicians, the National Partnership for Women & Families, and seven other groups. In addition, the National Quality Forum (NQF) served as a technical adviser. (The core measures are available for download at http://tinyurl.com/j5zryd2.)
Quality professionals have criticized existing quality measures on two counts: Many were poorly developed, and there are just too many of them. The new measures are intended to decrease the burden of data collection while also improving the quality of the information, acting CMS Administrator Andy Slavitt said in announcing the change.
“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,” Slavitt said. “This agreement today will reduce unnecessary burdens for physicians and accelerate the country’s movement to better quality.”
The new core measure sets should accelerate quality improvement and make healthcare more effective and efficient, says Helen Burstin, MD, MPH, chief scientific officer with the NQF in Washington, DC.
“Clinicians need fewer and more meaningful measures to reduce the burden of reporting similar or lookalike quality measures to different entities in order to free up more time for direct patient care,” Burstin says. “Equally important, this effort helps provide consumers with comparable information to better inform healthcare decisions.”
The release of the collaborative’s core measures shows the willingness of the public and private sectors of healthcare to work toward more efficient and effective data collection, Burstin says. She sees that as an important signal to the healthcare quality professionals who must embrace the new measures if they are to be successful.
“I think it will take a little bit of time, with CMS’s rulemaking processes and health plans changing their contracts, to see this actually happen,” Burstin says. “But not a long time. I would expect to see some effects within a year or two.”
The collaborative views the upcoming year as a transitional period, as it begins adoption and harmonization of the measures. (Read further for more information on the timeline for adopting the core sets. (See the story later in this issue for NQF’s assessment of another quality-related program from the Department of Health and Human Services.)
CORE MEASURES APPLY TO HOSPITALS
Burstin notes that most of the measures are aimed at the clinician level, but there are measures at the facility level as well, particularly in cardiology and obstetrics.
“That means it would be important for hospitals to have an eye toward which measures are part of the core set, make sure they’re comfortable with them, and begin measuring if they’re not already doing so,” Burstin says. “I think a lot of them will be ones they are already measuring, but there will be some that they should consider adopting.”
Familiarity with the core measures is particularly important now that insurers are contracting more directly with hospitals, Burstin explains. Core measures are likely to be embedded in the contracts, so she says hospitals would be wise to assess beforehand which of the measures are applicable to their services and begin collecting that data. (See the story later in this issue for more information on how the core measures will prompt hospitals to change data collection processes.)
Reaction to the core measures has been largely favorable, Burstin says.
“There certainly is more work to do down the line to continue to build more outcome measures into the set and more patient voice into the set, but it’s a great starting point,” she says. “We do know that it shouldn’t be carved in stone because as data systems improve and the ability to capture data beyond claims improves, this data set will continue to evolve.”
CONSISTENCY WILL BE KEY
Standardizing data collection through the core measures may still prove challenging, says Andrew Boyd, PhD, professor of health informatics at the University of Illinois at Chicago, an expert in data simplification and clinical outcomes. Though the intention is to have everyone collect the same information, that won’t be easy even if hospitals are all using the same core measures, he says.
The core measures will require collecting more or different data elements than some hospitals are already collecting, and in many cases those data points will involve assessments that are fairly straightforward, with agreed-upon definitions. Some activities of daily living, for instance, might produce data that is reliably consistent across all providers. But in other cases, the data may not be so consistent.
“The big challenge is that the government will come out with definitions and rating scores, trying to make them as objective as possible, but it’s impossible for every hospital and every other healthcare facility to always agree on the exact same meaning of all the terms,” Boyd says. “The intent is to minimize that inconsistency, but that can happen only when everyone is using the same definitions.”
That means that a top priority for hospitals will have to be understanding the meaning of terms and definitions in the core measures, Boyd says. Otherwise, data for the healthcare industry as a whole is devalued, and quality is jeopardized in transition of care.
“If someone is completely dependent on someone else to feed them, that’s one level, and if they’re able to feed themselves that’s the other end of the scale,” Boyd explains. “You can get consistent data collection on those, but in between there are gradations. Providers even in the same hospital will have different opinions, so the definitions have to be as clear as possible. Making the information meaningful for healthcare providers is going to be the challenge.”
Boyd is hopeful that the core measures will improve data collection and quality of care, but he has doubts. One of his concerns is that the government doesn’t have a good track record of making clear the criteria for assigning particular codes to a patient or service. With billing codes, for instance, research has shown that it is common for there to be up to 40% disagreement among clinicians on a diagnosis, yet that is not reflected in the attached code.
“The quality of that data is not as high as we would hope, but you don’t get paid without putting a code on. People end up just assigning a code without thinking that it will really affect patient outcomes. It’s just another checkbox,” he says. “This has potential to improve patient transitions, but the healthcare providers have to believe there is value in the data. If not, they will just assign a value and move on. They have other things to do.”
SOURCES
- Andrew Boyd, PhD, Professor of Health Informatics, University of Illinois at Chicago. Telephone: (312) 996-8339. Email: [email protected].
- Helen Burstin, MD, MPH, Chief Scientific Officer, National Quality Forum, Washington, DC. Telephone: (202) 783-1300.
CORE MEASURES WILL CHANGE DATA COLLECTION
The seven core sets of quality measures released recently by the Core Quality Measures Collaborative will require hospitals to change the way some data is collected, says David Nace, chief medical officer at MarkLogic, a software company in San Carlos, CA. Nace has more than 20 years of senior management experience in large healthcare systems, payer health plans, leading healthcare providers, and health information technology organizations.
“The big story here is not so much on the standardization of assessment instruments, but rather moving the ball forward on standardizing quality and financial measures, and thus requiring the integration of data from multiple silos,” Nace says.
Nace notes that the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 instructs CMS to require post-acute care providers to collect, integrate, and report standardized patient assessment data and quality measures — and that the data be interoperable for exchange with other providers to facilitate longitudinal and near or real-time coordination of care. The collaborative’s core measures are intended to make that more of a reality, he says.
“The reason the assessment instruments are highlighted is that the data you start with will dictate the data to collect in an ongoing fashion to track and manage patient care, specifically cost, quality, and outcomes,” he says. “A key driver of the initiative is to allow for transparency in comparing provider costs, quality, and outcomes — and thus allow for well-informed choices by those choosing or steering others to providers, and allow for continuing learning environments for the providers themselves.”
Data across multiple sources first has to be brought together, matched up with the right patient, and made accurate and reliable, says Ramon Chen, data management expert and chief marketing officer with Reltio, a company in Redwood Shores, CA, that provides data management services. Existing healthcare systems do not need to be immediately replaced, he says, but organizations need to leverage new modern data management capabilities so post-acute care data analysis can occur against a reliable data foundation.
“Standards are always desired and an ultimate goal. But enforcing standards is a difficult task without technologies that can govern and ensure that information conforms. Even with validation at source, there will always be errors such as mistyped names, addresses, and other details,” Chen says. “An ideal platform is one that can both guarantee standard entry, continuously validate information across all sources, reconcile and match details between systems, and provide a collaborative framework to review errors and correct them manually if needed.”
SOURCES
- Ramon Chen, Chief Marketing Officer, Reltio, Redwood Shores, CA. Telephone: (855) 360-3282.
- David Nace, Chief Medical Officer, MarkLogic, San Carlos, CA. Telephone: (650) 655-2300. Email: [email protected].
More on Value-based Purchasing Programs
The National Quality Forum’s (NQF) Measure Applications Partnership (MAP) released two reports outlining cross-cutting issues that affect the delivery of healthcare in hospitals and hospital settings (including dialysis facilities and ambulatory surgery centers) as well as post-acute care and long-term care (PAC-LTC) settings.
These reports, submitted to the Department of Health and Human Services (HHS), highlight important considerations for the federal government when selecting performance measures related to the care provided to 55 million Americans insured by Medicare in these settings, says Helen Burstin, MD, MPH, chief scientific officer with the NQF in Washington, DC.
“As the healthcare system shifts to new delivery and payment models that promote shared accountability and greater responsibility for patient outcomes, performance measurement must keep pace,” Burstin says. “The 150 expert MAP volunteers continue to emphasize the need for better measures in federal programs; the increased engagement of providers, families, and patients; and a more coordinated approach to delivering care across the different healthcare settings — from hospitals to post-acute and long-term care facilities.”
The “MAP 2016 Considerations for Implementing Measures for Federal Programs—Hospitals” report:
- encourages better integration of hospitals with PAC-LTC settings by leveraging measurement to spur enhanced care coordination and data sharing to avoid unnecessary hospital readmissions,
- emphasizes the need to engage patients and families as partners in care and notes ways in which measurement can facilitate this essential goal, and
- highlights the need for improved interconnectivity and information-sharing among patients, providers, and payers to ensure that health data and information plays a central role in decision-making processes.
The report is available online at http://tinyurl.com/hlgdf9z.
The “MAP 2016 Considerations for Implementing Measures for Federal Programs—PAC-LTC” report finds the following:
- Further testing is needed of measures intended to promote alignment across PAC-LTC settings to ensure they reflect specific patient populations while acknowledging differences in healthcare goals.
- Measure concepts for the PAC-LTC settings should reflect the effects of sociodemographic, socioeconomic, and psychosocial issues, as well as encourage patient and family engagement.
- Measurement gaps remain in care coordination, transitions in care, and other areas that matter to patients and caregivers.
- Shared accountability between providers across the care continuum remains a priority.
The report is available online at http://tinyurl.com/z8jpcqy.
This year, MAP reviewed 44 measures under consideration for eight programs addressing hospitals, dialysis facilities, and ambulatory surgery centers and 32 measures for six programs addressing PAC and LTC settings.
Responding to criticism from healthcare institutions that quality measures have become too numerous and diverse, CMS is adopting a core set of quality measures with the intention of standardizing data collection and making it more meaningful. But will this change have much effect on hospitals?
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