The National Quality Forum's Measure Applications Partnership has taken the unusual step of suggesting the federal government consider culling approximately one-fifth of the metrics it uses to determine payment in seven federal healthcare programs.
The recommendation came as part of its 2017 guidance to HHS, released Thursday. It suggested HHS think about removing 51 of 240 measures currently used to determine payment in those programs, to help streamline requirements for providers and make healthcare measurement more efficient.
“We want to make sure we can take away measures that are adding burden but not value,” Dr. Helen Burstin, NQF's chief scientific officer, told reporters in a call. “This is really just the start.”
Every year since 2011, the Washington, D.C.-based NQF, which is responsible under federal contract for recommending quality measures to HHS, has convened the multi-stakeholder Measure Applications Partnership to review those measures, which are used in public reporting programs and federal value-based payment initiatives for the 55 million people covered by Medicare. The final decision on which measures to use is up to the CMS, which may need to engage in rulemaking in order to make changes.
Federal healthcare programs currently contain 634 quality measures, and the healthcare industry has long contended that the reporting and data collection requirements for these measures impose too much of a burden on providers. At the same time, the industry is grappling with how best to pay for healthcare on the basis of value, not volume, a system that requires the sector to accurately measure the quality of care.
In its guidance, MAP called for reducing measure burden, in part by removing measures that are considered irrelevant or useless. The recommendation came after MAP's annual convention, held earlier this year, had an agenda with something different from previous years: an overview of the full set of measures.
Looking at the full picture of measures allowed MAP participants to examine the measures' aggregate impact on providers, from their unintended consequences to the time spent reporting them. “The burden of gathering the needed data that is necessary to produce these measures is a real concern,” said Dr. Harold Pincus, co-chair of the MAP Coordinating Committee.
This year, the measures MAP recommended removing included four out of 18 measures used in the End-Stage Renal Disease Quality Incentive Program, 13 out of 29 used in the Outpatient Quality Reporting Program and six out of 62 used in the Inpatient Quality Reporting Program. It also recommended removing measures from the Prospective Payment System-Exempt Cancer Hospital Quality Reporting Program, the Ambulatory Surgery Center Quality Reporting Program, the Inpatient Psychiatric Facility Quality Reporting Program and the Home Health Quality Reporting Program.
MAP also looked at measures used in the Merit-Based Incentive Payment System of the Quality Payment Program, which, under the 2015 Medicare Access and CHIP Reauthorization Act, changes the way Medicare pays doctors. It also looked at measures in the Medicare Shared Savings Program. It did not recommend removing measures from MIPS, but said that those programs needed higher-value measures, including outcome measures.
These recommendations were different from MAP's final recommendations, released in February, regarding 74 new measures that the federal government is considering using. Those recommendations ultimately supported 33 measures but asked the CMS to refine or stop work entirely on the other 41.
In its guidance, MAP also emphasized the need for higher-value measures, defined as outcome measures, especially patient-reported ones; measures addressing patient experience, quality of life, or impact on equity; appropriateness and efficiency measures; composite measures; and process measures connected to patient outcomes.
These recommendations build on MAP's observations from the previous year that existing measures left gaps in the areas of patient-reported outcomes, functional status and care coordination.
Some areas of healthcare have too few measures, noted Dr. Ron Walters, a member of MAP's hospital workgroup, and figuring out how to have appropriate measures in the right areas—enough to drive improvement, but not too many to be burdensome—remains a challenge. “It's that back-and-forth balancing of too few, and too many,” he said.