CMS, Yale New Haven Health on hot seat over design of quality measures
Skip to main content
Sister Publication Links
  • Modern Healthcare Metrics
MDHC_Logotype_white
Subscribe
  • Subscribe
  • Register
  • Login
  • News
    • This Week's News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Nurses recycle surgical wraps for the homeless
      Nurses sew surgical wraps into sleeping bags for the homeless
      Wright Lassiter III
      Healthcare leaders urge full court press on social determinants of health
      Joan Budden
      Q&A: Priority Health CEO eager to share best practices with Total Health Care
      Capitol Building with pills
      Week Ahead: House to vote on drug bill; SCOTUS hears risk-corridor case
    • November was healthcare's second strongest hiring month of 2019
      Primary-care provider ChenMed to enter five new markets
      Lacking specialist access drives health disparities
      Genetic Counseling
      Addressing barriers to expanding genetic counseling
    • Joan Budden
      Q&A: Priority Health CEO eager to share best practices with Total Health Care
      Silver-loading, CSR elimination lowered premiums for some rural enrollees
      Centene to sell Illinois plan to CVS Health
      Blue Cross of Idaho unveils souped-up short-term health plans
    • Capitol Building with pills
      Week Ahead: House to vote on drug bill; SCOTUS hears risk-corridor case
      MedPAC thinks hospice payments are too high
      MedPAC says ambulatory surgical centers don't need a pay raise
      States focus on healthcare costs to address coverage problems
    • Analysts to CommonSpirit Health: Show us the savings
      Smallest hospitals saw biggest earnings gains last month
      Sutter Health postpones financial filing
      doctor helping patient stock image Sandoz
      Sponsored Content Provided By Sandoz
      As hospital executives look to reduce costs, biosimilars offer a compelling option
    • astronaut
      Astronauts developed bloodstream issues in space
      Sponsored Content Provided By ABM Healthcare
      Protecting and Maintaining Medical Devices
      human hand robotic hand stock image
      Sponsored Content Provided By Deloitte
      The Health System of the Future: How Digital Health Technology is Transforming Care
      EHR
      EHR vendors most in-use throughout Medicare incentive program
    • MRIs of dense breasts find more cancer but also false alarms
      Flu season takes off quickly in Deep South states
      Uber driver says South Carolina hospital dumped patient on him
      1 in 3 adults age 45 and older reported being lonely in a 2018 AARP survey
      Data Points: Loneliness and its impact on health
    • Jim Allison playing the harmonica
      Documentary tells tale of Nobel winning researcher
      Seema Verma
      Seema Verma's bold initiatives land her in No. 1 'Most Influential' spot
      New CEO takes the helm at Lurie Children's Hospital of Chicago
      Mayo Clinic taps Dr. John Halamka to lead its Google partnership
    • Midwest
    • Northeast
    • South
    • West
  • Special Features
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • Chest x-ray from a patient with a vaping-related lung injury
      Vaping-related cases lead to care guidelines from Intermountain
      Arkansas Children’s was a founding partner in Solutions for Patient Safety.
      Children's hospitals collaborate rather than compete on patient safety
      Peer recovery specialists at St. Barnabas Medical Center work with nurse Brenna Zarra.
      Peer recovery helping patients with addiction seek treatment
      UNC Health Care trains staff to treat dementia patients
    • Linda Kenney
      Patient advocate recalls two medical errors that nearly killed her
      Leah Binder, CEO of the Leapfrog Group, with her grandmother, Estelle Greifer.
      With no national reporting system, volume of medical errors is still unknown
      Man in hospital bed
      Minnesota looks to evolve its patient-safety reporting system
      Dr. Don Berwick
      Despite progress, we’re still waiting for a truly safer healthcare system
    • Randy Oostra, CEO of ProMedica
      HCR ManorCare deal laid foundation for ProMedica’s growth
      Advanced ICU Care
      Telemedicine helps rural hospitals meet intensivist shortage
      Paging Dr. Robot: Artificial intelligence moves into care
      A child being screened for vision problems using a smartphone.
      App screens kids for eye problems before they can talk
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • ProMedica doubles down on social needs data analysis
      Amazon taps first pharmacy for Alexa Rx management
      Trump administration unveils new price transparency rules
      A child being screened for vision problems using a smartphone.
      App screens kids for eye problems before they can talk
    • VA dives into artificial intelligence R&D
      Home health to pare down therapy services, up telehealth offerings
      Amazon launches medical transcription service
      Hospitals' uncompensated care continues to rise
    • Chest x-ray from a patient with a vaping-related lung injury
      Vaping-related cases lead to care guidelines from Intermountain
      Advanced ICU Care
      Telemedicine helps rural hospitals meet intensivist shortage
      Peer recovery specialists at St. Barnabas Medical Center work with nurse Brenna Zarra.
      Peer recovery helping patients with addiction seek treatment
      UNC Health Care trains staff to treat dementia patients
    • Value-based pay still struggles to improve costs, quality
      Hospitals sue HHS over negotiated price disclosure rule
      Bundled payments get a boost in two states with employee programs
      CMS wants primary-care docs to take on financial risk
  • Data/Lists
    • Rankings/Lists
    • Data Points
    • Modern Healthcare Metrics
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Randy Oostra, CEO of ProMedica
      HCR ManorCare deal laid foundation for ProMedica’s growth
      Steve Strongwater
      How Atrius Health stayed independent by not shying away from risk
      Why moving the VA to a new EHR was a pivotal decision
      Why AdventHealth's rebrand was more than a name change
    • Terry Shaw
      A diverse and inclusive culture should empower others
      Paving the path to diversity and inclusion
      The next step in healthcare evolution
      Breaking Bias: A road map to boost women and minorities into healthcare leadership
    • Dr. Richard Snyder
      Outdated privacy laws hinder coordinated care, especially in the fight against addiction
      David Dill and Keith Myers
      Healthcare partnerships are a proven path to better care, healthier communities
      Health systems need to devote more resources to caring for the caregivers
      Chip Kahn and Alan Morgan
      Rural healthcare needs innovation, policy changes to survive
    • Letters: Let’s keep humanity in discussions about patient safety
      Hospital with money
      Letters: Let providers set their prices,
 and then publish them all
      Letters: Ambulatory surgery centers aren't getting a break on regulation
      Letters: Rising Medicaid spending isn't a windfall for providers
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Nominate
    • Award Programs
    • Previous Award Programs
    • Other Award Programs
    • Nominations Open - Top 25 Minority Leaders
      Nominations Open - Health Care Hall of Fame
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • Kronos webinar logo lockup
      Sponsored Content Provided By Kronos
      Webinar: The Future of Work in Healthcare
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Critical Connections: Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Minority Leaders Gala (2020)
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Safety & Quality
January 19, 2019 12:00 AM

CMS, Yale New Haven Health on hot seat over design of quality measures

Maria Castellucci
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    GETTY IMAGES

    The CMS' long-standing hospital readmissions penalty program has taken quite a beating recently from members of the research community over problems with its underlying measures.

    But while criticism of the program has escalated, not everyone has joined the bandwagon. Dr. Harlan Krumholz, a well-known researcher at Yale New Haven Health, passionately defends the measures, and with good reason: He led the group that helped the CMS develop the readmission measures as part of a multimillion-dollar contract the agency gave to the academic healthcare institution.

    Still, dissatisfaction with the way the readmissions program is designed is coming to a head, and possibly has exposed some fundamental flaws with not just the readmissions program but the CMS' measure-designing process, including those found on Hospital Compare and part of the CMS' value-based purchasing programs.

    “I think the measures we end up with are a function of the process we use for the development of these measures … and none of the processes that we use are really particularly good,” said Francois de Brantes, senior vice president of commercial business development at healthcare consultancy Remedy Partners who has experience bidding for CMS contracts.

    Drawing attention to the CMS' Hospital Readmissions Reduction Program in the past month were two studies published in different journals. One—published in late December in JAMA—found mortality rates rose slightly among heart failure and pneumonia patients after the readmissions program went into effect, mirroring another study published in November 2017 that came to similar conclusions.

    The other recent study—published this month in Health Affairs—found that reductions in readmissions rates may be related to coding changes the CMS made around the time the program was implemented. This was the second study in the past year to suggest that the reductions in readmissions may have been overestimated.

    The research has raised concerns across the healthcare industry, and a CMS spokeswoman said it's “thoroughly” reviewing both the recent studies to “inform any future actions.”

    “Any finding in the medical literature suggesting that CMS programs may be associated with increased mortality is of deep concern, and we take the safety of our patients very seriously,” the spokeswoman added.

    But the studies don't dissuade Krumholz from defending the program. When the JAMA piece was published in late December finding a correlation between rising mortality rates and the readmissions program, Krumholz published a Twitter thread knocking it down with some of his own studies. One of those, published last July in JAMA, found that among hospitals that reduced 30-day readmission rates, 30-day mortality rates after discharge actually decreased slightly. The first author of the study, Dr. Kumar Dharmarajan, is also affiliated with Yale. JAMA discloses in the study that the authors work under contract with the CMS but doesn't say Yale New Haven was integral to developing the CMS' readmission measures.

    Krumholz and Yale have a decadelong history with the CMS. Krumholz led the development of the risk-adjustment model the agency uses for the readmission measures and his employer has received about $135 million from the CMS since 2009 to develop and maintain the readmission measures, along with several other quality measures embedded in agency programs. Krumholz admitted his ties to the CMS in his December Twitter thread but the research community is largely silent on his interest, possibly out of fear of rebuke.

    “Nobody in academia was willing to bring up the fact that Harlan might have some conflicts—there are reasons he is so invested in the program,” said Dr. Anish Koka, a cardiologist in private practice who recently wrote a blog post for the Accad & Koka Report about funding Yale has received from the CMS through contracting.

    “I don't think it is a secret that I am … involved in the design of the readmission measures and that I work with CMS to build tools to support policies to improve healthcare,” Krumholz said in an email exchange with Modern Healthcare. “CMS has never asked me or anyone on my team to defend the readmission policy.”

    Problem with the programs?

    Health policy analysts who have personally experienced or witnessed how the CMS contracts with groups like Yale to develop quality measures say the recent questions raised about the readmissions program demonstrate the shortcomings deeply embedded in the CMS' contracting process for quality measure development. Currently, the CMS' quality measures rely heavily on expertise and research from a select handful of organizations that receive millions of dollars to do so.

    As a result, the industry uses measures that lack diversity and rigor, the analysts said. “Ideally, we would have more competition and innovation in measure development,” said Dr. Karen Joynt Maddox, an assistant professor of medicine at the Washington University School of Medicine in St. Louis who has studied the readmissions program. “By having the same contractors year upon year, it means we are locked in to how they want to do things.”

    The CMS uses organizations to develop and maintain quality measures through a contract called Measure and Instrument Development and Support, known as MIDS, and a review of public documents shows that the CMS contracts with the same groups.

    Yale New Haven Health and 17 other organizations currently have a $800 million contract with the CMS to develop quality measures. Yale has received about $110 million from the contract since 2013 and the funding expires this year. Yale New Haven is the biggest awardee of the MIDS contract for 2013, and the institution is responsible for a plethora of hospital quality measures in use today.

    Along with its work on all of the readmission measures, Yale New Haven has developed the methodology for the overall hospital star ratings, which has been panned by quality researchers and hospital stakeholders, and for many of the measures on Hospital Compare, like acute myocardial infarction mortality, pneumonia mortality and elective hip or knee replacement complications. The work typically comes out of the Center for Outcomes Research and Evaluation, which is affiliated with the Yale School of Medicine and Yale New Haven Hospital; Krumholz is the center's director.

    In August, the CMS announced that Yale New Haven was selected with 30 other organizations for another contract to develop quality measures, this time with a funding cap to the groups of $1.6 billion. Of the 18 awardees from the 2013 MIDS contract, 16 were awarded again for the 2018 MIDS contract.

    A CMS official said in an interview with Modern Healthcare that the agency hasn't intentionally selected a relatively small number of organizations for its MIDS contracts. Rather, the pool of organizations who can do the work is not very large.

    “We want to ensure that whoever we are contracting with either themselves or they have access to subcontractors who have the requirements, expertise and experience. These measures that are being developed are being used for payment on a national scale,” she said. “I believe our standards for what we are looking for are rigorous, and they ought to be given what is at stake. … There are not hundreds and hundreds of organizations that have that” expertise.

    The CMS official noted that the number of organizations with measurement development expertise is growing, which is reflected in the increase in organizations the CMS awarded to be part of its most recent MIDS contract.

    “There are more people getting into this space and developing the experience because measurement has become one of those tools not just used by us, but commercial payers too,” she said.

    But a Modern Healthcare review of the 2013 MIDS contract shows Yale, Mathematica Policy Research and Health Services Advisory Group were by far the largest awardees of CMS' $800 million funding pool, while two organizations didn't get any funding at all for projects.

    RELATED STORY: How the CMS picks winners of valuable quality measure contracts

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    Modern Healthcare
    Copyright © 1996-2019. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Special Features
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Data Points
      • Modern Healthcare Metrics
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Critical Connections: Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Minority Leaders Gala (2020)
      • Webinars
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing