CMS and Private Insurers Align Quality Measures

On February 16, the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP), as part of the Core Quality Measures Collaborative initiative, released seven sets of quality measures that can be used to assess physician performance and patient care, and to determine reimbursement.  CMS and the private insurers are working to streamline and harmonize the measures currently in use.  In recent years, many insurers have adopted differing quality measures, which have been added to the regulatory burden of providers.

The first ‘harmonized’ core measure sets cover:

• Accountable Care Organizations, Patient Centered Medical Homes, and Primary Care;
• Cardiology;
• Gastroenterology;
• HIV and Hepatitis C;
• Medical Oncology; and
• Obstetrics and Gynecology; and
• Orthopedics.

According to the agency, this initiative will promote:

• Evidence-based quality measurement;
• Better consumer decision-making;
• Value-based payment and purchasing;
• A reduction in the variability in quality measures; and
• A decrease in provider costs.

CMS and its partners plan to release additional core sets.  The agency plans to use the notice and rulemaking-process to develop and implement future core measure sets.