CMS Vision for Quality Measurement and Public Reporting

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1 CMS Vision for Quality Measurement and Public Reporting Annual Policy Conference Federation of American Hospitals Kate Goodrich, M.D., M.H.S. Quality Measurement & Health Assessment Group, Center for Clinical Standards and Quality June 17-18, 2014

2 Conflict of Interest Disclosure Kate Goodrich, MD MHS Has no real or apparent conflicts of interest to report.

3 Quality Measurement and Health Assessment Group 4 divisions (ambulatory care, hospital, post-acute care, Program management support) and about 85 staff Implement 12 quality and public reporting programs, and support 17 others Partner with external stakeholders to align measures across public and private sectors Lead development of the quality measures and the CMS quality strategy Provide measure support to the Innovation Center, Exchanges, Medicaid and many others

4 CMS Quality Strategy Initiatives-Patient-Assessment- Instruments/QualityInitiativesGenInfo/ CMS-Quality-Strategy.html

5 Our Three Aims Better Health for the Population Better Care for Individuals Lower Cost Through Improvement 5

6 The Six Goals of the CMS Quality Strategy 1 Make care safer by reducing harm caused in the delivery of care 2 Strengthen person and family engagement as partners in their care 3 Promote effective communication and coordination of care 4 Promote effective prevention and treatment of chronic disease 5 Work with communities to promote healthy living 6 Make care affordable INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

7 Foundational Principles of the CMS Quality Strategy Eliminate disparities Strengthen infrastructure and data systems Enable local innovations Foster learning organizations

8 Quality Measurement Strategy

9 CMS framework for measurement maps to the six National Quality Strategy priorities Clinical quality of care Care type (preventive, acute, post-acute, chronic) Conditions Subpopulations Care coordination Patient and family activation Infrastructure and processes for care coordination Impact of care coordination Population/ community health Health Behaviors Access Physical and Social environment Health Status Measures should be patientcentered and outcome-oriented whenever possible Person- and Caregivercentered experience and outcomes Patient experience Caregiver experience Preference- and goaloriented care Safety All-cause harm HACs HAIs Unnecessary care Medication safety Efficiency and cost reduction Cost Efficiency Appropriateness Measure concepts in each of the six domains that are common across providers and settings can form a core set of measures

10 CMS Vision for Quality Measurement Align measures with the National Quality Strategy and Six Measure Domains Implement measures that fill critical gaps within the 6 domains Develop measures meaningful to patients and providers, focused on outcomes (including patient-reported outcomes), safety, patient experience, care coordination, appropriate use, and cost Align measures across CMS programs whenever possible Parsimonious sets of measures; core sets of measures Removal of measures that are no longer appropriate (e.g., topped out or process distal from outcome) Align measures with states, private payers, boards and specialty societies

11 Three Categories of CMS Programs Pay-for-Reporting (Example: IQR) Provider incentivized for to report information. Pay-for-Performance (Example: HRRP) Provider incentivized to achieve targeted threshold or clinical performance Pay-for-Value (Example: HVBP) Incentives linked to both quality and efficiency improvements.

12 Value-Based Purchasing Goal is to reward providers and health systems that deliver better outcomes in health and health care at lower cost to the beneficiaries and communities they serve. Five Principles - Define the end goal, not the process for achieving it - All providers incentives must be aligned - Right measure must be developed and implemented in rapid cycle - CMS must actively support quality improvement - Clinical community and patients must be actively engaged VanLare JM, Conway PH. Value-Based Purchasing National Programs to Move from Volume to Value. NEJM July 26, 2012

13 Focusing on Outcomes Focusing on the end results of care and not the technical approaches that providers use to achieve the results Measure 30 day mortality rates, hospital-acquired infections, etc Determine if desired clinical results are achieved (low re-admissions, weight reduction, etc )

14 Challenges in Measuring Performance Determining indicators of outcomes that reflect national priorities Recognizing that outcomes are usually influenced by multiple factors Determining thresholds for good performance Recognizing that Process Measures don t always predict outcomes

15 CMS Priorities for Measure Development Common Adverse Events Global measure of harm? Appropriate Use of Resources Patients with Multiple Chronic Conditions Aligning measures and incentives across providers Actively monitor for unintended consequences Advance science on Patient-Reported Outcome Measures De novo e-measure development 15

16 Vision for Quality Reporting Programs Vision Implement a unified, aligned set of clinical quality measures and reporting requirements to synchronize and integrate CMS quality programs which will reduce provider reporting burden and maximize improvement on patient outcomes Report Once Hospitals: Inpatient Quality Reporting Program (IQR), Hospital Value-Based Purchasing (HVBP), and the EHR incentive program for Meaningful Use. Eligible Professionals: Physician Quality reporting System (PQRS), Physician Value Modifier (PVM), EHR Incentive Program for Meaningful Use, and Medicare Shared Savings Program (ACOs)

17 Public Reporting and 5 Star Ratings

18 Current Public Reporting Sites 5 Stars Nursing Home Compare Medicare Advantage Plan Finder Physician Compare Marketplace (future) Not 5 Stars Hospital Compare Home Health Compare Dialysis Facility Compare 18

19 Stepwise Progression to 5 Star By end of 2014, early 2015 begin transition to 5 stars By 2016, fully transition to 5 star ratings Any new sites begin with 5 star ratings IRF, LTCH, Hospice, ASC, etc. 19

20 Principles for 5 star ratings Report what is most important to patients in a way they can understand Leverage knowledge and lessons learned from existing 5 star sites Report only valid data! Not all measures are appropriate for 5 star ratings Transparency of methodology and display with stakeholders Coordinate across all Compare sites 20

21 Questions? Thank You! Contact Information Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group Centers for Clinical Standards and Quality

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