Medicare's new quality program targets measurement fatigue

The CMS is preparing to cull the number of quality metrics that physicians have to report as it rolls three quality-incentive programs into what Congress conceived as a more harmonized framework.

The agency's proposed regulations, which carry out last year's Medicare Access and CHIP Reauthorization Act, make some progress toward addressing the mounting measurement fatigue physicians face under a patchwork of programs with various metrics and reporting requirements.

But that doesn't mean the process will be simpler right away. Clinicians face a steep learning curve as unprepared practices scramble to get up to speed. The first performance period would begin Jan. 1 under the draft regulations issued last week.

The new framework consolidates three existing incentive programs into a “cohesive program that avoids redundancies,” the CMS said in the rule. But industry groups and experts aren't completely convinced yet.

“Practices care about the overall burden, and I don't think this reduces that,” said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association.

The new Merit-Based Incentive Payment System, or MIPS, reduces the total number of measures that practices are required to report on to six, compared with nine under the Physician Quality Reporting System, one of the three eliminated incentive programs. But MIPS also increases the percentage of relevant instances physicians have to report for each measure, raising the bar “so high it could be impossible for some to reach,” Gilberg said. And they won't know until November whether they can keep using the same measures they've been using under the existing programs.

At least one of the six new measures has to be cross-cutting, meaning the metric can broadly apply across multiple clinical settings. There must also be at least one clinical outcomes measure, which tracks how patients actually fared after receiving care. The CMS plans to add more outcomes measures over time, eventually phasing out process measures.

While fewer metrics may reduce some of the reporting burden, it's going to take time for practices to adjust, said Blair Childs, senior vice president of public affairs for Premier, which provides healthcare group purchasing and performance-improvement services.

“Not everyone is ready,” Childs said. “Those that are will be advantaged. Knowledge is power, and in this case the power has financial consequences.”