CMS, Private Payers Announce Physician Quality Measures

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By Sara Hansard

Feb. 16 — Seventy percent of commercial payer enrollees—including those covered by UnitedHealth Group, Aetna, Anthem, Cigna, Health Care Service Corp., Humana, Kaiser Permanente and the Blue Cross Blue Shield Association—as well as Medicare patients will be covered by new quality measures announced Feb. 16 by the CMS and America's Health Insurance Plans (AHIP).

Confusing and sometimes overlapping measurement and reporting on quality measures required of physicians will be replaced by a set of seven measures that will be used to define and measure quality by commercial payers and the Centers for Medicare & Medicaid Services, acting CMS Administrator Andy Slavitt said in a press call.

The Core Quality Measures Collaborative will cover accountable care organizations, patient-centered medical homes and primary care providers, among other groups, Slavitt said. The CMS will implement the new core measures across applicable Medicare programs “while eliminating redundant measures that are not part of the core set,” he said.

Health insurers have been calling for the CMS to align quality standards for public programs such as Medicare and Medicaid with commercial plans, arguing that it is difficult for plans to implement different sets of standards unless the giant public health-care program has the same requirements. Physicians have also argued that they are faced with too many redundant and conflicting quality measures that often don't improve care delivery.

Multipayer Alignment for First Time

The measures support multipayer alignment for the first time primarily for physician quality programs, the CMS said in a release. The CMS, commercial plans, Medicare and Medicaid managed care plans, the National Quality Forum, employers, physician organizations and patient groups worked on developing the standards over 18 months through the collaborative, which will continue, it said.

AHIP convened the collaborative, according to a fact sheet. More measures will be added and the current measures will be updated over time, the CMS said. The core measures announced Feb. 16 are for:

  •  accountable care organizations, patient-centered medical homes and primary care;
  •  cardiology;
  •  gastroenterology;
  •  human immunodeficiency virus and hepatitis C;
  •  medical oncology;
  •  obstetrics and gynecology; and
  • orthopedics.

    Majority of Measures Already in Use

    “The vast majority of these measures are already in use in CMS programs,” Patrick Conway, acting principal deputy administrator and chief medical officer of the agency, said on the press call. Through its annual rulemaking process, the CMS will propose measures that aren't currently included in its programs, and “if we have additional measures or duplicative measures that are in our current programs, we would look to propose to remove those measures through our normal notice and comment rulemaking processes as well,” he said. That process will begin this year, he said.

    “By aligning quality measures across public and private payers it helps providers deliver higher quality care to patients,” Conway said.

    The Health Care Payment Learning and Action Network, a public-private collaboration established by the CMS, will integrate the quality measures into their efforts to align payment models with public and private sector partners, and the CMS is working with the Office of Personnel Management, the Department of Defense, the Department of Veterans Affairs and state Medicaid plans to align quality measures where appropriate, the CMS said in a release.

    `Huge Step Forward' for Family Physicians

    The average family physician practice deals with at least seven payers, public and private, “and each of those payers currently has their own performance measurement system,” as well as different reporting methods, Douglas Henley, executive vice president and chief executive officer of the American Academy of Family Physicians, said on the press call.

    The core measure set for primary care released Feb. 16 includes some 21 measures that are “a huge step forward,” Henley said. Family physicians now have between 50 and 100 measures to which they must pay attention, which “creates a lot of chaos and confusion, as well as administrative burden and complexity, and interferes with overall performance improvement and improved patient outcomes,” he said.

    The American Medical Association, which is participating in the initiative, issued a release Feb. 16 saying that while it is “still a work in progress, the evidence-based measure sets presented today represent an important first step in establishing a model for future collaboration on performance measure alignment in these and other areas.”

    Commercial Plan Implementation

    “The commercial plans are going to use a phased-in approach” to implement the measures that will depend on when contracts are renewed or when measures within the contracts are going to be changed, beginning with contracts starting in 2017, Carmella Bocchino, executive vice president of AHIP, said on the press call. “We're going to start tracking which of these get implemented and how we go forward from there.”

    The new set of specifications will allow for public reporting of physician measures that are comparable, allowing identification of high performers, Bocchino said.

    Other health plans that are participating in the collaborative include Blue Care Network, Blue Cross Blue Shield of Massachusetts, Cambia Health Solutions, Group Health Cooperative, Harvard Pilgrim Health Care and the AmeriHealth Caritas Family of Companies, AHIP spokeswoman Clare Krusing told Bloomberg BNA in an e-mail Feb. 16.

    To contact the reporter on this story: Sara Hansard in Washington at

    To contact the editor responsible for this story: Janey Cohen at