For more than a year, top officials from Medicare, the nation's largest health plans, medical societies and major employers and consumer groups hammered away at a dreadful task: getting everyone to agree to use identical quality measures for the treatment of heart disease, cancer and other common conditions.
Previous attempts have failed, but this one did not. Participants in this effort, called the Core Quality Measures Collaborative, announced the first fruits of their work last Tuesday.
Now the real negotiations begin.
The collaborative released a list of standard quality measures for primary and accountable care, and separate lists for six medical specialties. Medicare and commercial insurance companies pledged to use the standards in a growing number of physician and hospital contracts that tie quality performance to payment. That could reduce the burden and confusion doctors face as they track and report on a growing and diverse number of quality measures. Patients, meanwhile, should find it easier to compare doctors on quality.
But first, Medicare has to modify the regulations that prescribe different quality measures, or don't include those adopted in the new standardized sets. Private insurers must negotiate the quality measures in each contract as it comes up for renewal.
In addition to ACOs and primary care, the CMS aims to streamline its quality measures for cardiology, gastroenterology, HIV and hepatitis C, medical oncology, obstetrics and gynecology, and orthopedics.
Whether the new standards are widely adopted will depend on public rulemaking and the degree to which standards are included in contracts hammered out by health plans, physicians and hospitals. Though widely endorsed, the switch to the consensus measures in commercial plans is voluntary.
“What we don't want to do is to unilaterally make a change,” said Dr. Andrew Baskin, national medical director for quality and provider performance measurement at Aetna. The Hartford, Conn.-based insurer won't require use of the new standard measures but will use them as a “starting point” as the insurer enters or renews contracts.
Contract terms for quality measures vary for many reasons, and some reasons are more compelling than others. One is the evolving science around measuring healthcare processes and outcomes. Another, however, is that providers prefer targets they can achieve.