The CMS wants to eliminate 19 measures across the agency's five quality and value-based purchasing programs as part of its larger goal to reduce the administrative burden for providers. The agency also aims to eliminate redundancies in 21 measures.
In its annual proposed rule for the inpatient and long-term care prospective payment system, the agency said the changes would decrease hospitals' time spent on paperwork by more than 2 million hours and result in $75 million in savings.
Experts say the CMS' suggested changes are a positive step overall for the field of quality measurement. There are too many measures that serve little value to clinicians or patients. But they also questioned CMS' reasons for removing some measures, particularly those related to patient safety.
The CMS proposed to dissolve some patient safety measures either because they were already measured in another program or the cost of the measure outweighed the benefit. However, safe care is still a major problem at hospitals that requires continued measurement, argued Francois de Brantes, an independent healthcare consultant and former director of the Center for Payment Innovation at the Altarum Institute.
"There's a reason why some of these measures are there," he said. "Improvements on patient safety aren't anywhere close to where they should be."
Andrew Wilson, research team leader at the Altarum Center for Value in Health Care, also questioned CMS' reasons for cutting some payment measures. The agency said it's too costly to report them even though they are collected via claims. "I don't understand if you're measuring resource use using claims how it's a cost to the hospital," he said.
CMS' rationale for removing some measures:
- CAUTI, C. difficile, CLABSI, surgical site infection and MRSA outcome measures: Duplicative in Hospital-Acquired Condition Reduction Program.
- Hospital Survey on Patient Safety Culture: Measure does not result in better patient outcomes.
- Safe-surgery checklist use: Cost of the measure outweighs the benefit.
- Hospital 30-day, all-cause, risk-standardized mortality rate for AMI, CABG surgery, COPD hospitalization, heart failure and pneumonia: Duplicative in the Hospital Value-based Purchasing Program.
- Hospital 30-day, all-cause, risk-standardized readmission rate for AMI,CABG,COPD,heartfailure,pneumoniaandtotalhiporkneesurgerypatients: Duplicative in the Hospital Readmissions Reduction Program.
- Cellulitis clinical episode-based payment measure: Cost of the measure outweighs the benefit and the data are also captured under a more broadly applicable measure—Medicare Spending Per Beneficiary.
- Influenza immunization: Measure performance is "topped-out".
- Incidence of potentially preventable venous thromboembolism prophylaxis: Cost of the measure outweighs the benefit.
- Home management plan of care document given to patient/caregiver: Cost of the measure outweighs the benefit.
- Stroke education: Cost of the measure outweighs the benefit.
- Assessed for rehabilitation: Cost of the measure outweighs the benefit.
