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Resources to Drive Performance and Profitability:

By: Lisa Remington, President Remington Health Strategy Group and Publisher, The Remington Report

 One of the steps in the pre-rulemaking process requires that HHS make publicly available, not later than December 1 annually, a list of quality and efficiency measures HHS is considering adopting, through the federal rulemaking process, for use in certain Medicare quality programs.

CMS will continue aligning measures across programs whenever possible with the goals of moving payment toward value, improving outcomes for patients, and reducing regulatory burden for clinicians and providers through focusing everyone’s efforts on the same quality areas.

In order to achieve these objectives, CMS has identified 19 Meaningful Measures and mapped them to six overarching quality priorities.

Meaningful Measures Framework Domains and Measure Areas

1. Quality Priority: Make Care Safer by Reducing Harm Caused in the Delivery of Care

 Meaningful Measure Area:

• Healthcare-Associated Infections

• Preventable Healthcare Harm

2. Quality Priority: Strengthen Person and Family Engagement as Partners in Their Care

Meaningful Measure Area:

• Care is Personalized and Aligned with Patient's Goal

• End of Life Care According to Preferences

• Patient Reported Functional Outcomes

3. Quality Priority: Promote Effective Communication and Coordination of Care

Meaningful Measure Area:

• Medication Management

• Admissions and Readmission to Hospitals

• Transfer of Health Information and Interoperability

4. Quality: Promote Effective Prevention and Treatment of Chronic Conditions

Meaningful Measure Area:

• Preventive Care

• Management of Chronic Conditions

• Prevention, Treatment, and Management of Mental Health

• Prevention and Treatment of Opioid and Substance Use Disorder

• Risk Adjusted Mortality

 5. Quality: Work with Communities to Promote Best Practices of Healthy Living

Meaningful Measure Area:

• Equity of Care

• Community Engagement

6. Quality: Make Care Affordable

Meaningful Measure Area:

• Appropriate Use of Healthcare

• Patient-Focused Episode of Care

• Risk Adjusted Total Cost of Care

 

NUMBER OF MEASURES UNDER CONSIDERATION BY PROGRAM 2019

 CMS

 

Number of Measures under Consideration

Ambulatory Surgical Center Quality Reporting Program

0

End-Stage Renal Disease Quality Incentive Program

0

Home Health Quality Reporting Program

2

Hospice Quality Reporting Program

1

Hospital-Acquired Condition Reduction Program

0

Hospital Inpatient Quality Reporting Program

3

Hospital Outpatient Quality Reporting Program

0

Hospital Readmissions Reduction Program

0

Hospital Value-Based Purchasing Program

0

Inpatient Psychiatric Facility Quality Reporting Program

1

Inpatient Rehabilitation Facility Quality Reporting Program

2

Long-Term Care Hospital Quality Reporting Program

2

Medicare and Medicaid EHR Incentive Program for Eligible Hospitals and Critical Access Hospitals

3

Medicare Shared Savings Program

5

Merit-based Incentive Payment System—Cost

13

Merit-based Incentive Payment System—Quality

8

Prospective Payment System-Exempt Cancer Hospital Quality Reporting Program

1

Skilled Nursing Facility Quality Reporting Program

2

Skilled Nursing Facility Value-Based Purchasing Program

0

 

Remington’s Key Takeaways About Meaningful Measures

Stakeholder Impact:

• Connecting to Patients

Meaningful Measures focus health care quality efforts on what is really important to patients, families and caregivers including making informed decisions about their care, aligning care with the patient’s goals and preferences and improving quality of life and patient outcomes.  It is intended to highlight that the patient- the patient’s needs, values, preferences and health outcomes - is fundamental to the Meaningful Measures areas and quality domains. 

For example, in addition to identifying distinct Meaningful Measure areas including Patient’s Experience of Care and Patient Functional Status to focus on the quality domain of Strengthening Person and Family Engagement as Partners in Their Care, all other Meaningful Measure areas have central goals surrounding the patient as well.  It is also intended to promote understanding by individuals and caregivers of the importance of health care quality measurement to improve patient outcomes.  With everyone’s efforts focusing on the same high impact quality areas, there will be less burden of reporting for clinicians and providers and in turn, an even better ability to focus on patients and providing appropriate care that is meaningful to them.

• Connecting to Clinicians and Providers

The Meaningful Measures framework applies a series of cross-cutting criteria that will apply to every quality measure and help guide the removal of lower value quality measures across CMS programs while keeping measures that have less burden and are most meaningful with the greatest impact on patient outcomes. This will allow clinicians and providers the ability to focus on patients and improve quality of care in ways that are meaningful to them instead of reporting and paperwork. CMS is prioritizing the use of outcome measures though high priority process measures will continue to be considered in cases where outcome measures might not be possible.

• Connecting to Specialists

Meaningful Measures are intended to capture the most impactful and highest priority quality improvement areas for all clinicians, including specialists. For example, functional outcomes and health care associated infections are cross-cutting areas for measurement across all settings of care. Taking orthopedic surgeons as an example, CMS has heard from patients and surgeons that the patient’s functional outcomes after surgery are important to them. Measuring patient-reported functional outcomes data can help illuminate whether the surgery has been effective in improving or maintaining patients’ quality of life. In addition, for specialists such as surgeons and clinicians performing procedures, we know that prevention of complications such as infections is an important outcome. It is applicable from birth to death throughout the lifespan of a patient across care settings.

• How the Meaningful Measure Areas Impact Existing CMS Programs

Meaningful Measures is not intended to replace any existing programs, but will help programs identify and select individual measures. Meaningful Measure areas are intended to increase measure alignment across CMS programs and other public and private initiatives. Additionally, it will point to high priority areas where there may be gaps in available quality measures while helping guide CMS’s effort to develop and implement quality measures to fill those gaps.

Read the recommended Meaningful Measures for 2019:

Meaningful_Measures_2019.pdf

Additional Remington Resources:

Are Meaningful Measures a Transition Into PAC Value-Based Care? Or, a Bridge from Fee-For-Service to Value-Based Care. Remington Report magazine, November/December 2018 - pages 4-7.

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