CMS to Stress Outcomes Over Process in Quality Reporting

Ken Terry

November 01, 2017

The Centers for Medicare & Medicaid Services (CMS) has launched a new public-private initiative to change the focus of quality reporting from measuring processes to measuring patient outcomes. But it is unclear how soon this program will be able to develop measures of patient-reported outcomes and related health information technology so as to have a significant impact on physician practice.

The other goal of CMS' Meaningful Measures program is to reduce the reporting burden on physicians and hospitals. The agency views this as a by-product of the shift from process to outcomes measures.

"Meaningful Measures will involve only assessing those core issues that are the most vital to providing high-quality care and improving patient outcomes," said CMS Administrator Seema Verma when she announced the initiative in a speech at the Health Care Payment Learning and Action Network (LAN) Fall Summit in Arlington, Virginia. "It's better to focus on achieving results, as opposed to having CMS try to micromanage and measure processes."

Verma summarized the complaints of many healthcare providers about the difficulty of reporting quality data to multiple payers, each of which use different measures. She cited family physicians who report nearly 30 measures to seven different payers, and she noted that all of this reporting costs practices a lot of money. However, she did not suggest how CMS might persuade private payers to agree on a common set of metrics.

Serma also did not say that CMS' new approach to quality reporting would have any effect on what physicians must do under the soon-to-be-released final rule for CMS' Quality Payment Program, which was authorized by the Medicare Access and CHIP Reauthorization Act (MACRA). However, she said, "We know that MACRA is a tremendous change, so we're taking it slow to make the transition as smooth as possible."

In addition, she said that CMS is "revising quality measures across all programs to ensure that measure sets are streamlined, outcomes-based, and meaningful to doctors and patients." Neither her speech nor CMS' press announcement gave a timeline for the development of these new metrics.

PROM Time

To create the new outcomes measures, CMS will seek help from LAN, the National Academ of Medicine, the Core Quality Measures Collaborative, and the National Quality Forum, Verma said.

Intermediate outcomes, such as particular blood pressure and blood sugar levels, can be measured with devices and lab tests. But the kinds of outcomes that CMS is interested in are chiefly gauged by patient reports. A large number of patient-reported outcomes measures (PROMs) have been developed during the past 30 years but are little used in clinical care.

In a report on PROMs, the National Quality Forum (NQF) said that many of these measures have been evaluated and catalogued by the Patient Reported Outcomes Measurement Information System of the National Institutes of Health. One reason these metrics are hardly being used, NQF said, is that "little is known about aggregating these patient-level outcomes for measuring performance of the healthcare entity delivering care." More work must also be done to determine the best ways of collecting these data, the report said.

According to a recent post by Neil Wagle, MD, in NEJM Catalyst, the blog of the New England Journal of Medicine, if patient-reported data are to be used, they must be in electronic form on a platform that integrates with electronic health records, such as a patient portal. In addition, clinicians must be persuaded that the data are valuable enough to warrant the effort of perusing it. Nevertheless, Dr Wagle's organization, Partners Healthcare, in Boston, is now collecting PROMs in 21 specialties, including orthopedics, urology, psychiatry, and cardiac surgery, he wrote.

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