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CMS, AHIP release core quality measures to align documentation

February 16, 2016
by Pamela Tabar, Editor-in-Chief
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The Centers for Medicare & Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) have jointly released seven sets of clinical quality measures, some of which will touch the long-term and post-acute care sectors.

The seven core measurement sets are:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs), and Primary Care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics

The effort is one of the first steps in a national strategy to align insurers and providers under the same quality measures, reducing the reporting burden on clinicians. The seven sets of core measures are the first time multiple payers have been joined under common reporting measures.

Some of the core sets involve extracting data from electronic health records (EHRs), which could be a challenge for providers who don’t currently have an integrated EHR. “While some plans and providers may be able to collect certain clinical data, a robust infrastructure to collect data on all the measures in the core set does not exist currently,” the CMS fact sheet on the program states. “The implementation of some measures in the core set will depend on availability of such clinical data either from EHRs or registries. Providers and payers will need to work together to create a reporting infrastructure for such measures.”

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to create rules to solve the confusion among clinicians and payers as to what constitutes quality and how it is measured. Several of the core sets involve clinical data stored in electronic health records

“In the U.S. Health care system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality,” said CMS Acting Administrator Andy Slavitt, in today’s CMS announcement. “This agreement today will reduce unnecessary burden for physicians and accelerate the country's movement to better quality.”

The upcoming 12-month period will be considered a transition year while insurers and providers implement the new core measurement sets, CMS said. Meanwhile, the Quality Measures Collaborative will monitor the progress and gather feedback on how the process can be improved.

Read the CMS fact sheet explaining the background of the initiative, as well as how the program will be implemented.