The Changing Landscape of Quality Measures in Healthcare

In the rapidly changing world of value-based care, quality measures in healthcare that accurately reflect whether a clinician has met the standard of care are critical to improving patient outcomes and creating reimbursement models.

While data collection is vital to value-based care, clinician burnout also needs to be addressed. Clinicians continue to express frustration regarding the administrative burden of clinical documentation and data collection, as well as a lack of actionable information resulting from quality data capture. These issues continue to be barriers in delivering effective value-based care.

To respond to these issues, the Centers for Medicare and Medicaid Services (CMS)—as part of their Quality Payment Program (QPP)—recently finalized significant changes to how quality is measured. Their proposal is to adopt a new system of quality measures in healthcare for the Merit-Based Incentive Payment Systems (MIPS) program: MIPS Value Pathways or MVPs. The new approach to quality measures in healthcare focus on:

1. Making performance requirements less confusing
2. Reducing complexity when selecting and reporting measures
3. Improving performance comparability for all clinicians

Quality Measures in Healthcare Value Pathways

MVPs are disease-state or specialty-specific measurement subsets for activities that integrate quality improvement performance, enhance care and reduce costs. CMS would also use submitted claims to drive overarching population health measurement. Instead of choosing measures and activities to report for each category, MIPS participants would report one MVP, including all measures and activities in the MVP.

For example, an endocrinologist would likely select the diabetic care MVP. The diabetic care MVP will likely have quality measures around HbgA1C and blood pressure control, improvement activity measures determining if the clinician offers glycemic control services or case management, and measures determining how meeting the standard of care impacts cost.

The shift to MVPs is a shift from flexibility to standardization, and requires more accountability and potential financial incentives for specialists in multispecialty organizations that have historically reported primary care focused measures. CMS feels the MVPs reduce confusion and eliminate the complexity of measure selection. In the current iteration of the MIPS program, individual clinicians can select from over 250 individual quality measures, each with a variety of allowable reporting mechanisms. The MVP identifies a predetermined set of measures specific to the disease state, simplifying the choice for eligible clinicians.

In addition, the MVPs will improve performance comparability for all eligible clinicians. Under the MVP concept, specialists who focus on a particular disease state will be reporting the same quality measures as all other eligible clinicians treating the same disease state. For example, if diabetes is the primary disease state focus for a particular clinician, that clinician will report on the same set of measures as every other clinician who selects the diabetes MVP. This creates a much more meaningful performance benchmark for every MIPs-eligible clinician.

Challenges and Opportunities

CMS plans to roll out MVPs in calendar year 2021. This means 2020 represents a remarkable opportunity for HIMSS members to advise CMS on how to create MVPs which will drive the most impactful improvements in patient outcomes.

CMS also has to overcome significant barriers associated with the MVPs. Many specialties lack electronic clinical quality measures to populate MVPs. Increased requirements around data completeness for the samples submitted to CMS to populate quality measures—coupled with the continuing requirement for multispecialty organizations to capture and report data through multiple reporting mechanisms—could potentially increase the existing administrative burden associated with quality reporting. HIMSS has strongly advocated for the measurement tools for all value-based care programs around the globe to:

1. Accurately reflect the quality of care being delivered
2. Minimize the burdensome data collection on clinicians
3. Provide real-time access to performance data on meaningful measurements of quality
4. Drive improvements in patient care delivery and outcomes

While the 2021 deadline for implementation set by CMS will allow very little time for a thoughtful consideration of which evidence-based model practices and improvement activities best support MVPs, HIMSS and other stakeholders will actively develop guidance to drive the development of MVPs to meet these criteria before being adopted as part of the MIPS program.

The challenges are not unique to the United States. Defining the appropriate processes for improving patient outcomes, making data actionable to drive process improvement and reimbursing based on accurate measurement of care quality are pain points globally regardless of payment model.