CMS will collaborate with a broad group of stakeholder organizations and persons to develop measures that are important to both patients and clinicians and that represent important performance gaps in the targeted quality domains.
MACRA identifies five quality domains:
- clinical care;
- care coordination;
- patient and caregiver experience;
- population health and prevention
Measures developed under the MDP align with the National Quality Strategy and the CMS Quality Strategy. CMS is also taking into consideration the quality domain of affordable care. MACRA further establishes priorities for the types of measures to be developed, which shall include outcome, patient experience, care coordination, and measures of appropriate use of services, such as measures of overuse of clinical procedures.
“MACRA requires the MDP to consider applicability across health care settings in developing quality measures for MIPS and advanced APMs.”
Strategic Approach: CMS has identified initial priorities for each of the domains through input from multi-stakeholder groups (e.g., the MAP), stakeholder input from public comment on the draft plan, and analysis of the PQRS preferred measure sets by specialty. Key priority topics include shared decision-making and personal preferences, misdiagnosis and diagnostic accuracy, medication safety, team-based care, clinical outcomes, and early detection of chronic disease. In addition, CMS has prioritized addressing specialties and professionals with a limited number of applicable measures (e.g., orthopedic surgery, palliative care, pathology, radiology, mental health and substance use, oncology).
MACRA requires the MDP to consider applicability across health care settings in developing quality measures for MIPS and advanced APMs. The law also requires quality measures used in APMs to be comparable to the quality measures used in MIPS.