CMS quality measures might not indicate the actual care patients receive, according to a new Government Accountability Office report.
The GAO studied how the agency decides what quality measures to develop and use. It also evaluated how the CMS monitors its funding for quality measurement activities.
The watchdog found that the CMS doesn't have processes to make sure that the indicators actually measure what the agency says it cares about in its strategic objectives. The GAO found that the CMS carries over large sums of unused funds each year for activities related to quality measurement. And that the CMS fails to keep track of all its quality-measurement funding.
The CMS should create standard practices to assess the measures that it's considering to ensure they line up with strategic quality objectives, the GAO said. It also recommended that the CMS monitor its progress in achieving its goals by developing and using performance metrics. The GAO also said that the CMS should keep more comprehensive and thorough information on its quality funding.
HHS agreed with the GAO's recommendations.
In recent years, payers such as health plans have adopted quality measures to help them evaluate provider performance. They use them to reward providers for the value of the care they deliver instead of the volume of services they provide. Payers adjust their payments to providers based on how physicians and other staff perform according to specific metrics. Those metrics could include the rates at which a hospital's patients develop particular infections when they receive care, for example.
The CMS' decisions about which quality measures to use or whether to create new ones have a massive impact on the healthcare industry. That's because private payers can use Medicare's quality measures. Its choices affect both the quality of care that patients receive and how much providers get paid, whether they're enrolled in Medicare or not.
The CMS expected that in 2019, its Hospital Value-based Purchasing program would modify nearly $2 billion in Medicare Part A payments to hospitals.
Some providers and other stakeholders worry that the CMS quality measures don't accurately reflect the quality of care that patients receive. They're also concerned that they devote too much time and money reporting the data required by the Medicare quality measures.
But the CMS has tried to improve how it develops and selects quality measures over the past decade. The changes include more stakeholder input about the measures, and the Meaningful Measures Initiative that sets strategic objectives for its quality measures.
The GAO's report shows that it's still a work in progress.
