CMS’ 2015 National Impact Assessment of Quality Measures Report reveals progress toward the three aims of better care, smarter spending, and healthier people. The report examines the effectiveness of quality measurements used by CMS, summarizes key findings, and recommends next steps for even greater efficacy. The next Impact Report will be released in 2018, and current projections indicate that report will include almost twice as many quality measures as the current report as the program develops.
The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) requires CMS to issue these reports at least once every three years. This mandate stemmed from the gap between high quality care and care received by patients and the desire to improve care received. The ACA not only mandated the assessment of the quality impact of endorsed measures, but also required the development of the National Quality Strategy (NQS). CMS then aligned its goals with those in the NQS and it publicly reports the quality measures. This report includes trend analysis for data collected during three consecutive years between 2006 and 2012, and descriptive analysis for data available for fewer than three consecutive years, but in use through December 2013.
The study found that current CMS quality measures support the National Quality Strategy (NQS) and CMS Quality Strategy, however, significant gaps remain across all measure domains. The Affordable Care and Care Coordination domains are the most underrepresented. The CMS measures do reach a significant majority of the top 20 high-impact Medicare conditions experienced by beneficiaries. Further, improvement was shown in 95 percent of 119 publicly reported measure rates under these quality measures.
Patients affected by the use of quality measures were found to include more than just the Medicare population, as 40 percent of the Medicaid population and 30 percent of individuals covered by other sources were also affected. No patterns that systematically exclude specific populations were found in the study.
Process measures, which address clinical guidelines for patient care, were likely to be high performing. Outcome rates for providers are found to improve more slowly than process measures. For approximately 35 percent of the measures, performance was so high that additional improvement will have little effect on patient outcomes. Although race and ethnicity disparities were much less pronounced in 2012 than 2006, these disparities persist and require additional attention.
CMS’ proposed action includes promoting transparency and more closely monitoring measure rates, comparing them within groups of providers treating in areas with minority and underserved populations. It also plans to further research what degree of alignment in quality measures between state and federal programs would benefit patients and providers.
CMS is already focusing on certain points for the 2018 Impact Report. Several recently introduced programs did not have enough data available for trend analysis for the current report, but will be heavily analyzed in the future. Patient-level data is a primary concern. A national provider survey will be conducted on the impact of quality measures at the provider level.