Centers for Medicare and Medicaid Services: National Impact Assessment of Quality Measures

This is the second assessment of the impact of the measures used in Centers for Medicare and Medicaid Services (CMS) quality reporting programs towards achieving the goals of providing high-quality, affordable healthcare to CMS beneficiaries. These national impact assessments are required at least once every three years by section 3014(b) (amended by section 10304) of the Affordable Care Act.  The first impact assessment report was published in 2012. The 2015 report includes an assessment of 25 CMS reporting programs, using data from 2006 to 2013. Both the 2012 and this 2015 report were prepared by the Health Services Advisory Group.

Among the assessment’s key findings:

+CMS achieved improved coverage and balance of its quality measures addressing the six measure domains related to the National Quality Strategy priorities. However, significant gaps remain across all measure domains. The affordable care and care coordination domains are the most underrepresented.

+CMS programs and measures reach a wide range of patients with high-impact conditions. The CMS Medicare quality measures reach a large majority of the top 20 high-impact Medicare conditions experienced by beneficiaries. However, measures addressing these high-impact conditions are not evenly distributed across CMS reporting programs.

+Less than half of the CMS quality measures aligned with other state and federal programs. For example, analyses of the measures used by some state programs and the Veterans Health Administration showed that over half of the measures are locally developed measures.

+CMS quality measures impact patients beyond the Medicare population. Over 40 percent of the measures used in CMS quality reporting programs include individuals whose healthcare is provided by Medicaid, and over 30 percent include individuals with other payer sources.

+Among the CMS quality measures, exclusions were varied in number and type, and provider discretion was allowed as an exclusion in over one-fourth of the measures.  However, this review did not find patterns that systematically exclude specific populations.

+Provider and facility characteristics reflective of available resources (e.g., practice size, size of population served, and location) appear to be associated with increased provider participation in quality reporting programs and higher performance on quality measures.

+Ninety-five percent of the 119 publicly-reported measures used by CMS showed improvement from 2006 to 2012. Measures that address clinical guidelines for patient care (process measures) were most likely to be high performing (i.e., measure rates exceeding 90 percent in the three final years for which data were available), suggesting process measures are more sensitive to provider quality improvement efforts than outcome measures. Process measures may have a limited lifespan, since performance benchmarks are more rapidly achieved. Further improvement on these process measures may provide marginal returns in terms of impact on patient outcomes.

+Widespread race and ethnicity disparities that existed in 2006 were much less pronounced in 2012.  However, disparities persist across programs, settings, and demographic groups. Performance on measures for American Indian/Alaska Natives and Native Hawaiian/Pacific Islanders improved the least.

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