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BPC Recommends America’s Health Care Delivery System Adopt Standard Evidence-Based Quality Measures

Monday, April 27, 2015

Washington, D.C. – The Bipartisan Policy Center (BPC) released a white paper today, Transitioning from Volume to Value: Consolidation and Alignment of Quality Measures, that recommends creating standardized quality performance measures that are user-friendly, meaningful, and outcome-oriented that can be integrated within our nation’s alternative payment and health care delivery reform models.

This release comes on the heels of Congress’s enactment of the Medicare Access and CHIP Reauthorization Act, which represents an important step toward transitioning America’s health care system from fee-for-service payments to new models that reward quality and value in patient care.

BPC health leaders believe that a critical next step is adopting standard quality measures that can be used across all healthcare payment and delivery systems to encourage quality of care, improved outcomes, and cost savings. There is little agreement among professionals in the field about which measures are best and how they should be used by patient, provider, and payer communities. There is also concern that a proliferation of measures is resulting in measurement fatigue.

For example, in the Medicare program alone, there were approximately one thousand measures used in the second quarter of 2013.  In a study of 29 private health plans, there is little consistency between private and public measures.

“The current system is broken,” said BPC Senior Vice President Bill Hoagland. “Our quality measures are not consistent across payers, creating significant administrative burdens for providers. Failure to address these shortcomings will not only impede the shift from fee-for-service to organized systems of care, but limits our ability to improve quality in these delivery models.”

BPC recommends employing a core set of quality measures across all payers and providers, including: 

1) Support ongoing private-sector efforts. Private-sector stakeholders, in coordination with the Centers for Medicare and Medicaid Services (CMS), should identify core measures for use across all payers and delivery systems. BPC supports ongoing private-sector efforts including: America’s Health Insurance Plans (AHIP) and primary and specialty care medical societies working in conjunction with CMS and the National Quality Forum (NQF).

2) Develop an easily understood quality rating system for consumers. Health-quality measures should be converted into a rating system that can be easily understood by consumers. Private stakeholders, CMS and consumer groups should work together to ensure the clarity and usability of such measures. For example, CMS could revise and improve Medicare’s star rating system. Current quality information is available to consumers in a wide variety of formats, which makes consistency and comparisons difficult.

3) Emphasize role of a standards-setting organization. Identifying and adopting core measures will require a national organization, such as the NQF, to develop a standard set of evidence and consensus-based measures through a collaborative and open process. This entity would continually endorse measures, recommend selection, and identify and resolve gaps and flaws in the measurement protocol.

4) CMS should promulgate measures for physicians, qualified health plans (QHPs), hospitals, post-acute care, and across all provider groups using the process outlined in the first recommendation of this paper. CMS should promote core measures as part of the Physician Quality Reporting System (PQRS) and other reporting initiatives and apply them across reimbursement models. Once providers adopt these core measures, they should be relieved of other reporting requirements under Medicare and should be credited with having met Medicare PQRS requirements.

5) Incentivize Medicaid and non-QHP state-regulated plans. States that implement core measures in Medicaid, including pediatric measures, should receive an increase in their federal match rate (FMAP) of one percent for the first two years of implementation for claims made by plans for providers reporting core measures to the states. States must use these measures in lieu of other duplicative measures to receive enhanced matching.

“The federal government can play a role in incentivizing stakeholders to agree on a core set of quality measures, but we cannot let the goal of having a perfect set of measures impede progress in the short-term,” said BPC Health Policy Director Katherine Hayes. “New models designed to lower costs and improve quality are proceeding at a rapid pace, and without a core set of quality measures, we are only seeing half the picture.”

Transitioning from Volume to Value: Consolidation and Alignment of Quality Measures is the fourth paper in a series that has been released over the past year offering concrete steps for transitioning America’s health care system from one that rewards volume (“fee-for-service”) to a more coordinated system of care that improves quality while lowering costs. Other papers include: Transitioning to Organized Systems of Care: Near-Term Recommendations to Improve Accountable Care Organizations in Medicare, and Transitioning to Organized Systems of Care: Medical Homes, Payment Bundles, and the Role of Fee-for-Service.

BPC’s Delivery System Reform Initiative is led by former Senate Majority Leaders Tom Daschle and Bill Frist, former White House and Congressional Budget Office Director Dr. Alice Rivlin, and former Ranking Member of the House Ways and Means Committee Jim McCrery.

While BPC’s Health Project is focused on developing and using core quality measures, BPC’s Prevention Initiative and Health Innovation Initiative are also exploring health care quality issues and will release their findings this year. Follow our work at www.bipartisanpolicy.org/topics/health for the latest on this important issue.

KEYWORDS: ACCOUNTABLE CARE ORGANIZATIONS, ALICE RIVLIN, BILL FRIST, BILL HOAGLAND, CENTERS FOR MEDICARE AND MEDICAID SERVICES, CHILDREN'S HEALTH INSURANCE PROGRAM, HEALTH CARE SPENDING, JIM MCCRERY, KATHERINE HAYES, MEDICAID, MEDICARE, TOM DASCHLE