Healthcare Analytics, Population Health Management, Healthcare Big Data

Quality & Governance News

CMS Outlines Future for Clinical Quality Reporting Programs

By Jennifer Bresnick

- Clinical quality reporting programs for physicians are getting a makeover as part of CMS’ ongoing efforts to better measure improvements in care quality, population health management, and patient safety, said Principal Deputy Administrator and Chief Medical Officer Patrick Conway, MD, in a CMS blog post earlier this week.  The strategic vision for the future of the Physician Quality Reporting System (PQRS) and other components of the CMS Quality Strategy will rely on alignment between healthcare data analytics, industry feedback, and ongoing payment reforms.

CMS and clinical quality reporting programs

The clinical quality reporting programs roadmap was released in conjunction with new statistics on the success of the PQRS program, which saw increased enrollment from the eligible provider community despite the large number of EPs subject to negative payment adjustments for non-participation. 

The new outline hopes to help the industry build on the positives from the program “to reach a future-state where measurement and public reporting are optimized to help achieve the CMS Quality Strategy’s goals and objectives, and therefore contribute to improved healthcare quality across the nation,” the document says.

“This Strategic Vision describes a long-term vision for CMS quality measurement for physicians and professionals and public reporting programs, and how they can be optimized and aligned to support better decision-making from doctors, consumers, and every part of the health care system,” Conway wrote. “The physician quality programs support our vision of a health system that achieves better care, smarter spending, and healthier people. These programs support incentives to providers, encourage improvements in care delivery, and deliver information to consumers.”

CMS has developed five guiding statements for the future of its clinical quality reporting programs:

• CMS quality reporting programs are guided by input from patients, caregivers, and healthcare professionals.

• Feedback and data drives rapid cycle quality improvement.

• Public reporting provides meaningful, transparent, and actionable information.

• Quality reporting programs rely on an aligned measure portfolio.

• Quality reporting and value-based purchasing program policies are aligned.

“The Strategic Vision evolved out of our desire to plan for the future in how we administer the Physician Quality Reporting System (PQRS), Physician Feedback/Value-Based Payment Modifier Program, and other physician quality reporting programs,” Conway explained.

As the recently implemented Sustainable Growth Rate (SGR) repeal changes the structure of CMS’ three key clinical quality reporting programs, “components of these physician programs will serve as the foundation for the Merit-based Incentive Payment System,” he continued. “The Strategic Vision describes in concrete terms how we will advance the goals and objectives for quality improvement outlined in the CMS Quality Strategy through these quality measurement and reporting programs.”

CMS hopes to include a broader array of quality measures that can be used to benchmark quality and improvement in a variety of care settings, as well as expand the use of measures that take into account improvement over time to better reward providers coping with financial constraints, complex patient populations, or a dearth of resources.  Clinical quality reporting programs will also incorporate population health management features that evaluate outcomes in an identified pool of patients rather than just surveying individual health.

“These quality measurements and public reporting goals and initiatives encourage stakeholder engagement; reduce participation burden for healthcare professionals; and support meaningful public reporting,” Conway concluded. “Our long-term vision for physician quality reporting programs and the improvement of these programs challenges us to continue striving for excellence in healthcare quality over the next several years.”

To read the entire Strategic Vision document, please click here.

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