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Reform Update: CMS advances quality initiatives in draft payment rule


By Sabriya Rice
Posted: July 7, 2014 - 4:15 pm ET
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The CMS plans to expand public reporting through the Physician Compare website and require more practices to share patient-experience data. The agency also intends to eliminate “topped out” quality measures deemed no longer useful in assessing the performance of accountable care organizations.

Quality and safety experts say these proposals included in the 600-plus-page draft rule for the 2015 physician fee schedule are a step in the right direction toward increasing transparency and improving on the ability to track outcomes in a significant and comparable way.

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In 2016, the agency said, the Physician Compare website—which was established under the Patient Protection and Affordable Care Act—should reflect all 2015 data from the Physician Quality Reporting System, Group Practice Reporting Option Web interface, registries and EHR measures for group practices of two or more eligible physicians and accountable care organizations. The rule also recommended requiring that data meet the minimum sample size of 20 patients.

Experts reviewing the proposal say efforts around transparency and the release of meaningful quality data on physicians and their practices are commendable.

“Opportunities to accelerate the release of this data would benefit both those who use, and those that pay for, our healthcare system by improving the understanding of where quality exists today, and what gaps need to be addressed,” said Matt Austin, assistant professor at the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine.

The CMS proposal also adjusted the measures reported via the Physician Quality Reporting System. According to the CMS, 28 measures would be added and 73 removed. For example, the agency is recommending two new measures for sinusitis and inflammation of the ear canal while removing ones for perioperative care, back pain, cardiovascular prevention, ischemic vascular disease, sleep apnea and COPD. There would be a total of 240 measures.

Though she could not speak to the specific measures listed, Ann Greiner, vice president of public affairs for the National Quality Forum, praised the agency for attempting to address “topped out” measures, or those that most organizations do very well on, in the Medicare Shared Savings Program for ACOs.

“We hear a lot about trying to get to a more targeted set of measures that really matter,” Greiner said. When performance is such that most providers are generally doing very well, it shows that progress has been made in that particular area and those measures can removed. “We see that as a positive. It can eventually help isolate those issues that are ultimately the most impactful.”

Finally, the CMS wants to raise the level of understanding about the value consumers place on patient experience. Under the proposed regulations, all group practices of two or more physicians who meet the specified sample-size requirements and collect data via a certified CAHPS vendor would have to start publicly reporting in calendar year 2016 on patient experience data from the previous year.

Greiner said patient experience information is something patients often request, and that the effort to collect that kind of data in a standardized, statistically significant and comparable way is a positive.

Among other items in the CMS proposed last week include, recommendations for downward payment adjustments beginning in calendar year 2015 to be applied to eligible professionals who do not satisfactorily report data on quality measures to the physician quality reporting system or participate in the qualified clinical data registry. The pay-for-reporting program uses a combination on incentive payments and penalties to encourage reporting.

The proposed rules will be open for comment on the Federal Registrar through 5pm ET on Sept. 2, 2014.

Follow Sabriya Rice on Twitter: @MHSRice


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