CMS Releases Core Measure Sets

On February 16, CMS and America's Health Insurance Plans ("AHIP") released seven sets of clinical quality measures as part of the Core Quality Measures Collaborative ("Collaborative") of health care system participants. The guiding principles used by the Collaborative in creating the measure sets are that they be meaningful to consumers, patients and providers while standardizing the industry's core metrics to reduce variability in measure selection, collection burden and cost. The new measures are the first to support multi-payer alignment on key measures for physician quality programs.

The seven core measure sets include: Accountable Care Organizations, Patient-Centered Medical Homes and Primary Care; Cardiology; Gastroenterology; HIV and Hepatitis C; Medical Oncology; Obstetrics and Gynecology; and Orthopedics. CMS has already begun to use measures from each of the core sets and will apply new measures across applicable Medicare quality programs following a notice and public comment rule-making process. Private health plans will implement the measures when contracts are renewed or if existing contract agreements allow performance measure sets to be modified.

CMS Hip-Knee Pilot Program Expected to Start in April

CMS is expected to begin testing a program in April that would make nearly 800 hospitals financially responsible for patients' wellbeing after undergoing hip and knee replacement procedures. The Comprehensive Care for Joint Replacement ("CJR") program will be applied in hospitals across 67 regions, including New York, San Francisco, Los Angeles and Orlando.

Under the program, hospitals can receive higher pay if their patients fare well in the 90 days following a joint replacement. Hospitals will be required to repay Medicare if their patients have complications after the procedure. Over 400,000 hip and knee replacements were performed on Medicare enrollees at the cost of $7 billion in 2014. A number of regions participating in the program have exhibited rates of post-surgery complications and infections three times higher at some hospitals than others.

The joint replacement program is a major initiative being led by the Center for Medicare & Medicaid Innovation, which is attempting to move away from Medicare's traditional fee-for-service model. Many on Capitol Hill expect Congress to create programs similar to CJR in the future as a way to expand the use of bundled payments and generate savings that can be used to offset federal spending.

CMS Releases FAQ on Public Health EHR Objective

CMS issued an FAQ outlining the steps that eligible hospitals participating in the Medicare Electronic Health Records ("EHRs") Incentive Program must take to meet the specialized registry objective for hospital-based specialists. The agency has published several FAQs on public health measures for meaningful use of EHRs and has posted additional guidance on the specialized registry reporting requirement in FAQs 13653 and 13657.

Health-Related Bills Introduced This Week

There were no health-related bills introduced this week as both chambers were out of session.

Next Week in Congress

The House and Senate return after a week off for district work. On February 24, HHS Secretary Sylvia Burwell will testify before the House Energy and Commerce Health Subcommittee in a hearing examining the HHS FY 2017 budget proposal. In the Senate, the Finance Committee will hold a hearing on opioid abuse, and the Health Education Labor and Pensions Committee will hold a hearing on the Zika virus.