The Centers for Medicare and Medicaid Services on Monday announced a new initiative intended to streamline quality measures, reduce regulatory burden and promote innovation in the healthcare industry as it transitions from fee-for-service to value-based payment.
The effort, called the Meaningful Measures initiative, is being described as a “new approach to quality measurement.” CMS Administrator Seema Verma made the announcement during a plenary session at the Health Care Payment Learning and Action Network (LAN) Fall Summit in Arlington, Va.
“We need to move from fee-for-service to a system that pays for value and quality—but how we define value and quality today is a problem,” Verma said. “We all know it: Clinicians and hospitals have to report an array of measures to different payers. There are many steps involved in submitting them, taking time away from patients. Moreover, it’s not clear whether all of these measures are actually improving patient care.”
According to the agency, the Meaningful Measures initiative will “involve only assessing those core issues that are most vital to providing high-quality care and improving patient outcomes,” while adding that CMS “aims to focus on outcome-based measures going forward, as opposed to trying to micromanage processes.”
Verma said CMS is “revising current quality measures across all programs to ensure that measure sets are streamlined, outcomes-based, and meaningful to doctors and patients” and that Meaningful Measures “takes a new approach to quality measures to reduce the burden of reporting on all providers.”
In August, Verma said that CMS would soon be announcing additional initiatives to ease the burden the federal government places on healthcare providers. In particular, she took aim at the burdensome regulations governing electronic health records which have made the practice of medicine difficult.
In her presentation on Monday at the LAN Fall Summit, Verma said that CMS is re-examining its “process for conducting quality measurement across the board,” such as implementing the Medicare Access and CHIP Reauthorization Act (MACRA) in a way that minimizes the burden and costs providers face in meeting the requirements.
“We’ve taken a hard look at MACRA and will continue to do so,” said Verma. “We know that MACRA is a tremendous change, so we’re taking it slow to make the transition as smooth as possible. It’s great that some are ready to move faster, such as larger systems of care. But, we need a system that can work for all providers across the country—urban, rural, small, and large—so that the transition does not push providers out of the system and result in fewer patient choices.”
Reactions from industry groups to the new CMS initiative were generally positive and cautiously optimistic. The potential impact to improve federal oversight of healthcare IT is laudable, some say.
“A quick review of the administrator’s comments are music to our ears,” said Mari Savickis, vice president of federal affairs at the College of Healthcare Information Management Executives (CHIME).
However, Jeff Smith, vice president of public policy for the American Medical Informatics Association, was guarded in his assessment of new CMS initiative.
“The goals are laudable, but the talking points have been with us for several years now,” observed Smith. “Measurement depends on agreed-upon definitions of quality, and in an electronic environment, it requires access to and use of computable data. If CMS is going to turn these talking points into reality, it will need to put forth far more resources and commit additional experts to a complete overhaul of electronic quality measures for value-based payments, as we called for nearly two years ago.”
At the same time, he noted that CMS has a “fairly robust Quality Measures Blueprint and CMS proposed changes to Evaluation & Management documentation guidelines as part of the recent CY 2018 Physician Fee Schedule rule, so there is reason to be optimistic.”
Smith contends that “if CMS makes this more than a passing priority, and if there is a fundamental review of quality measures in an electronic environment, then AMIA gladly supports this initiative.”
Other industry leaders say the intent of the approach is needed in the industry.
“There is growing frustration for those on the front lines providing care in a system that often forces them to spend more time pushing paper rather than treating patients,” said Rick Pollack, president and CEO of the American Hospital Association. “Too often, these regulatory requirements seem detached from good and efficient patient care. The regulatory burden is substantial and unsustainable, and reducing the administrative complexity of healthcare would allow providers to spend more time on patients, not paperwork.”
Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association, said MGMA supports the agency’s efforts to reduce regulatory burdens and ensure Medicare quality measurement is meaningful and actionable for medical practices.
“In a recent survey of our members, (lack of) clinical relevance was ranked as the top concern under the Medicare MIPS program,” added Gilberg. “We expect the 2018 Quality Payment Program Final Rule (implementing MIPS and APMs) to be released this week and are hopeful these new CMS policies will be consistent with this announcement.”
The Meaningful Measures announcement by CMS comes on the heels of the recent public launch of the agency’s Patients Over Paperwork Initiative, which seeks to removing regulatory obstacles that get in the way of providers spending time with patients.
“Regulations have their place and are important to ensuring quality, integrity, and safety in our healthcare system. But, if rules are misguided, outdated, or are too complex, they can have a suffocating effect on healthcare delivery by shifting the focus of providers away from the patient and toward unnecessary paperwork, and ultimately increase the cost of care,” said Verma during her remarks at Monday’s LAN event.
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