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CMS Quality Strategy and Quality Measurement

CMS Quality Strategy and Quality Measurement. AHA Annual Meeting. Dr. Patrick Conway, M.D., MSc CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director, Center for Medicare and Medicaid innovation Director, Center for Clinical Standards and Quality May 5, 2014.

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CMS Quality Strategy and Quality Measurement

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  1. CMS Quality Strategy and Quality Measurement AHA Annual Meeting Dr. Patrick Conway, M.D., MSc CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director, Center for Medicare and Medicaid innovation Director, Center for Clinical Standards and Quality May 5, 2014

  2. The Six Goals of the CMS Quality Strategy 1 2 3 4 5 6 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

  3. CMS framework for measurement maps to the six national priorities Greatest commonality of measure concepts across domains Care coordination • Transition of care measures • Admission and readmission measures • Other measures of care coordination • Measures should be patient-centered and outcome-oriented whenever possible • Measure concepts in each of the six domains that are common across providers and settings can form a core set of measures Population/ community health Clinical quality of care • Measures that assess health of the community • Measures that reduce health disparities • Access to care and equitability measures • HHS primary care and CV quality measures • Prevention measures • Setting-specific measures • Specialty-specific measures Efficiency and cost reduction Person- and Caregiver- centered experience and engagment Safety • Spend per beneficiary measures • Episode cost measures • Quality to cost measures • CAHPS or equivalent measures for each settings • Shared decision-making • Healthcare Acquired Infections • Healthcare acquired conditions • Harm

  4. CMS Quality Strategy: Foundational Principles

  5. CMS Vision for Quality Measurement • Align measures: • With NQS and 6 measure priorities/domains. • With external stakeholders (private payers, states) • Across CMS programs whenever possible • Create parsimonious or cores measure sets • Implement measures filling critical gaps (patient-reported outcomes, care coordination, appropriate use, etc.) in rapid cycle • Remove “topped-out” measures. • Goal is improvement over time

  6. Future Hospital Quality Measurement • Robust quality measures covering the 6 goals from the CMS Quality Strategy • Adopt Quality Measurement across care settings • Integrated quality reporting and pay-for-performance programs • Submit once and fulfill multiple quality programs

  7. Hospital Value Based Purchasing • Additional stakeholder input • Pre-rulemaking process to allow stakeholders to submit measure concepts and given input • Enables CMS to more quickly target measurement goals identified in Quality Strategy • Evolution of Quality Measures/Domains • Expanding measures’ focus to outcomes, patient experience and efficiency • New quality domains for FY 2017 based on Quality Strategy • Monitoring and evaluation efforts ongoing

  8. Hospital Readmission Reduction Program • 5 condition specific measures • AMI, HF, PN, COPD, THA/TKA • Strive to be parsimonious • All Cause Hospital Wide Readmissions (HWR) measure • Stakeholder support for this measure recognized by CMS • Likely lack statutory authority to implement measure as currently designed.

  9. Hospital Acquired Conditions Reduction Program • FY 2017: 5 Hospital Associated Infections will be implemented in addition to PSI-90 • CLABSI, CAUTI, SSI, MRSA, C. difficile • FY 2015 IPPS/LTCH PPS proposed rule • Seeking stakeholder input on electronically specified measures of all-cause harm

  10. Future State for CMS Programs • Improve quality of care using: • Robust quality measures. • Timely feedback to providers. • EHR’s in a meaningful manner. • Minimize reporting burden by: • Synchronizing performance and reporting periods. • Reduce number of required submissions by professionals for eCQM data to one. • Maximize efficiency by: • Using eCQM reported data for multiple quality programs.

  11. The Future of Quality Measurement for Improvement and Accountability Source: Conway PH,Mostashari F, Clancy C. The Future of Quality Measurement for Improvement and Accountability. JAMA 2013 June 5; Vol 309, No. 21 2215 - 2216 • Meaningful quality measures increasingly need to transition away from setting-specific, narrow snapshots • Reorient and align measures around patient-centered outcomes that span across settings • Measures based on patient-centered episodes of care • Capture measurement at 3 main levels (i.e., individual clinician, group/facility, population/community) • Example gaps areas to be filled: patient reported outcomes, care coordination, patient engagement, efficiency, etc • Why do we measure? • Improvement

  12. Contact Information Dr. Patrick Conway, M.D., M.Sc. CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer 410-786-6841patrick.conway@cms.hhs.gov

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