As pay-for-performance programs continue to expand in both scale and scope across the US health care system, the amount of administrative and clinical resources necessary to participate in these programs has correspondingly grown. Participating providers have been faced with increasingly burdensome reporting requirements due to a lack of standardization of quality measures and reporting mechanisms among the various payors. This lack of cohesion has led to significant compliance costs for providers seeking to participate and accurately report quality achievements to the various programs.
A break in the clouds appeared last week for providers and Accountable Care Organizations (ACOs), however. On February 16, 2016, the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP), a national association representing private health insurance payors, announced the first results from the Core Quality Measure Collaborative. The Collaborative, a joint effort between CMS, AHIP, the National Quality Forum, and other national provider organizations, was designed to generally assess physician and ACO quality measures, with an eye toward standardizing quality measures wherever possible. No distinction was made between payor type.

Initial Focus on Seven Clinical Areas

The Collaborative initially focused on seven clinical areas:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care;
  • Cardiology;
  • Gastroenterology;
  • HIV and Hepatitis C;
  • Medical Oncology;
  • Obstetrics and Gynecology; and
  • Orthopedics.

The Collaborative’s proposed core measures for each of these specialties can be accessed on CMS’s website. While certain of the proposed measures are already in use by CMS, the agency will implement all of the proposed measures in 2016 via the notice and comment rulemaking process. Commercial plans will implement the measures as part of the contract renewal process beginning in 2017.
CMS announced the Collaborative’s intention to continue its analysis of these seven clinical areas to ensure that the quality measures remain current. Additional clinical specialties will be addressed in the future. The Collaborative has published additional information about its work through some Frequently Asked Questions.

Payors’ Joint Effort May Benefit Providers

The Collaborative’s work is notable as this is the first time that federal and commercial payors have joined forces to publish quality standards for the provider community. This is a positive development for the provider community: Physician and ACO success in meeting quality standards as part of a pay-for-performance program can result in significant revenue for participating providers, and having the same quality standards for both federal and commercial payors should facilitate their ability to meet those standards. Further, costs to providers for accurate reporting of quality measures across multiple payor organizations should decrease. These are all steps in the right direction when considering pay-for-performance programs.
Close attention should be paid to the work of the Collaborative, as well as the proposed rules implementing the Collaborative’s model measures. It certainly appears that relief is on the horizon for providers laboring under the burden of reporting quality data to multiple pay-for-performance programs.