Reform Update: McClellan sees Pioneer quality measures having wide impact

Debate over quality measures among Medicare's first accountable care organizations and federal officials will likely have significance for the 220 (and growing) other accountable care efforts under Medicare, a former CMS administrator says.

Dr. Mark McClellan, director of the Brookings Institution's Engelberg Center for Health Care Reform and one-time head of the CMS, speaking at the National Accountable Care Organization Summit in Washington late last week said the CMS had not yet finalized a response to critics of quality targets as accountable care under Medicare enters its second year.

Those critics are among Medicare's Pioneer accountable care initiative, a group of 32 ACOs that agreed to sign the first and most ambitious contracts to test the payment model. In February, many of the Pioneers urged federal officials to put off more demanding quality measures for a year. The CMS rejected the request, but agreed to draft new performance benchmarks.

Those benchmarks have yet to be released.

McClellan said once final, the benchmarks could have implications for Medicare's second, larger accountable care effort. He said a group was formed with the CMS to tackle the benchmark and quality measure dispute and more was expected in coming weeks.

Accountable care, broadly speaking, rewards hospitals and medical groups that hold down the cost of medical care and simultaneously reach targets for quality performance. The quality targets are intended to help safeguard access to care for sick and costly patients as providers' income grows more dependent on delivering lower-cost services. It's no surprise that quality was widely discussed during the summit.

Sen. Ron Wyden (D-Ore.), who delivered the opening address at the summit, called for rule changes to Medicare's accountable care efforts that he argued would better serve patients and get at a major cause of rising healthcare spending: chronic disease. Wyden said any senior with more than one chronic condition should receive an individual plan for their medical care. Rules as they stand do not clearly define who should get care plans, he said.

The Center for Medicare and Medicaid Innovation, which oversees the Pioneer ACOs, is itself undergoing a bit of a transition.

Dr. Richard Gilfillan, head of the CMS Innovation Center, will leave the job at the end of the month.

Dr. Patrick Conway, who will step in as acting head of the Innovation Center after Gilfillan departs, did not make a scheduled appearance at the summit. In his place, Dr. Kate Goodrich, acting director of quality measures and health assessment for the CMS Center for Clinical Standards and Quality, updated the assembled industry executives about the agency's priorities and efforts. “You're getting third-string CMS,” she joked.

Goodrich said she the agency was working to streamline its quality measures and more quickly develop new ones. An effort underway to speed up measure development would reduce the typical three- to four-year process to 12 months, she said.

Electronic medical record developers may help improve patient-safety reporting under a new code of conduct that would exclude “gag clauses,” Modern Healthcare's Joe Conn reports. The voluntary code, released by the Electronic Health Record Association, comes ahead of expected recommendations for new regulations in response to healthcare information technology-created safety risks identified by the Institute of Medicine, he reported.

Performance on quality can influence 3% of primary-care doctors' compensation, and slightly less (2%) for specialty physicians, according to new MGMA data, reports Modern Healthcare's Rachel Landen. The median primary-care doctor earned roughly $216,460 in 2012 while specialists earned roughly $388,200.