On February 16, 2016, the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) announced multi-payer alignment and simplification of core quality measures to be used in calculating quality-based payments for seven physicians’ services specialties. Multi-payer alignment is expected to reduce the reporting burden for providers and to accelerate the nationwide shift to value-based payment. The seven specialties are: primary care (including quality measures for accountable care organizations and patient-centered medical homes), cardiology, gastroenterology, HIV and hepatitis C, oncology, obstetrics/gynecology, and orthopedics.
The core quality measures pertain to physicians’ services that will be affected by Medicare payment reforms enacted under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Many of these quality measures require data extracted from electronic health records (EHRs) and automated data registries.
This breakthrough was achieved through a Core Quality Measures Collaborative led by AHIP, medical officers of commercial health insurance issuers, CMS, the National Quality Forum (NQF), Medicare and Medicaid managed care organizations, and various organizations representing medical professionals and consumers.
Additional information on the CMS and AHIP joint announcement is available here. A New England Journal of Medicine article entitled “Standardizing Patient Outcomes Measurement” (Michael E. Porter et al., February 11, 2016) also offers superb insights on this topic.