“It’s less about the number of measures, and more about the quality of the measures we have,” Schneider said. “There's an interest in getting federal programs aligned around a smaller number of measures that have the greatest impact and moving those forward.”
The number of quality of metrics that providers are expected to report on has grown. Primary care physicians average about seven value-based care contracts that incentivize them to report on an average of 57 different quality measures annually to increase their pay, according to an August study published in JAMA Health Forum.
The Centers for Medicare and Medicare Services last year released a paper detailing plans to reduce to 70 more than 500 quality measures tied to reporting requirements across its programs.
NCQA is working with the Centers for Disease Control and Prevention, CMS and the Office of the National Coordinator for Health IT to find common ground on standards and the quality measure development process, Schneider said. Over the past five years, the organizations have focused on enabling a transition to digital measurement to reduce the cost and burden associated with reporting.
CMS in 2016 started requiring health systems to submit electronic clinical quality measures data, which are automatically extracted from patients’ electronic health records and reduce the burden of chart abstraction and measurement reporting on providers.
Given advances in technology and progress made on retooling legacy data systems, the industry will likely be able to achieve greater measure standardization in the next several years, Schneider said.
In the meantime, the increasing number of quality measures and insufficient resources to prioritize every one has left many health systems to decide for themselves which ones would be their areas of focus.
Chicago-based Rush University Medical Center prioritizes metrics around mortality, inpatient experience and hospital-acquired infections that are included in the majority of quality rating programs and payer incentive programs.
By concentrating on the most common measures used by organizations including CMS and the Leapfrog Group, hospitals can maximize the benefits of their data reporting efforts, said Dr. Brian Stein, the medical center’s chief quality officer.
Rush also combines funding and metrics from multiple payers’ incentive programs into one composite program that rewards primary care doctors for meeting goals around individual patients' blood pressure, screenings and diabetes management, Stein said.
MedStar Health has set up a task force for its 10 hospitals and 400 outpatient sites that names around 30 metrics for all facilities to prioritize annually.
The narrowed focus has helped MedStar Health drive improvement in areas including sepsis management and treatment, said Dr. Terry Fairbanks, senior vice president and chief quality and safety officer of the Columbia, Maryland-based health system.
While there is some overlap among measures required by different organizations, MedStar Health regularly provides feedback to CMS on the need for more alignment, Fairbanks said. The agency has generally been receptive to such requests, he said.
"Measures are good, and they do a good job of clarifying what's most important to the patient," Fairbanks said. "Consistency between those who measure us would help us focus."
URAC, an independent quality and safety nonprofit, tries to incorporate existing measures in its accreditation programs, said Dr. Shawn Griffin, president and CEO. Chosen measures have often been endorsed by other groups and have a direct impact on patients’ health outcomes, Griffin said.
“The fact of the matter is, you shouldn't have different goals for Aetna versus Cigna versus the federal government,” he said.
The Core Quality Measures Collaborative is the main organization where healthcare leaders drill down to a set of core quality measures that have the most meaning across payers.
Founded by AHIP, the National Quality Forum and CMS in 2015, the Core Quality Measures Collaborative has coalition members who work to identify high-value, evidence-based measures linked to better patient outcomes and eliminate metrics that are redundant or have inconsistent measure specifications.
Health plan or agency measures with no strong scientific evidence base or proof of their feasibility and usability often don’t add value and just amount to more work for providers, Schneider said.
Focusing on patient-reported outcome measures can also relieve the load for clinicians and allows for data that is meaningful to both patients and providers, according to Mate.
“My hope is that we don't eliminate or try to reduce quality measurement, but rather that we take steps to make quality measurement even more effective and efficient,” Mate said. “I believe that a lot of what we do improve are the things that we can measure.”
