CMS Adopts Standardized Set of Quality Measures

In the U.S. healthcare system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality”

On February 16, 2016 CMS and American’s Health Insurance Plan announced the release of seven (7) sets of clinical quality measures to be used across public and private payers. Providers have long had the administrative burden of tracking, collecting and reporting different quality metrics on a payer-by-payer basis. The core measures were developed as a necessary means to assist the healthcare industry’s ever present struggle with how to identify and reward high-quality healthcare.

Quality metrics play an increasingly important role in hospital reimbursement and, prior to the announcement, industry experts criticized existing quality measures as poorly developed, ineffective, and too numerous to be helpful. This announcement is a step towards driving quality improvement and ensuring that high-value, high-quality care is being incentivized and paid for.

The seven (7) sets of standardized quality measures include performance reporting for accountable care organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care; Cardiology; Gastroenterology; HIV and Hepatitis C; Medical Oncology; Obstetrics and Gynecology; and Orthopedics. CMS will continue to implement new core measures and eliminate those that are unnecessary or redundant in an effort to align quality reporting, and potentially provider payment, across the health care industry.

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