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Is Synchrony on the Horizon for Physician Quality Reporting Efforts?

April 28, 2015
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The release of a strategic vision for physician quality reporting from CMS, and a new report on ACO development, signal a potentially new era around outcomes harmonization

As if federal healthcare officials hadn’t laid out enough clarity around where things are going in terms of incentives to providers in U.S. healthcare during HIMSS15, on Thursday, Apr. 23, the federal Centers for Medicare and Medicaid Services (CMS) clarified things even further. As HCI reported  last week, the agency announced, via a blog post by Patrick Conway, M.D., principal deputy administrator and chief medical officer at CMS, the release of its strategic vision for physician quality reporting programs, describing a long-term vision for the agency’s M.D. quality reporting program, and a vision for physician quality reporting going forward.

As the blog noted, the agency believes that five principles will ensure that physician quality measurement and public reporting play a critical role in improving care, those five being:

  • Input from patients, caregivers, and healthcare professionals, which will guide those programs.
  • Feedback and data drives rapid-cycle quality improvement
  • Public reporting providers meaningful, transparent, and actionable information.
  • Quality reporting programs rely on an aligned measure portfolio.
  • Quality reporting and value-based purchasing programs are aligned.

In the CMS blog, Dr. Conway noted that “CMS relies heavily on quality measurement and public reporting to facilitate the delivery of high quality care. This strategic vision articulates how we will build up on our successful physician quality reporting programs to reach a future-state where quality measurement and public reporting are optimized to help achieve the CMS quality strategy’s goals and objectives.”

Conway further noted that “These quality measurements and public reporting goas and initiatives encourage stakeholder engagement; reduce participation burden for healthcare professionals; and support meaningful public reporting.”

Interestingly, also at the same time last week, the Oliver Wyman consulting firm reported that the number of accountable care organizations (ACOs) nationwide continued to rise in 2014, to the extent that nearly 70 percent of the U.S. population now lives in localities served by ACOs, and 44 percent lives in areas served by two or more ACOs. What’s more, the Oliver Wyman reported noted, ACOs of all kinds now collectively serve between 49 and 59 million U.S. residents, or between 15 and 17 of the nation’s people.

The synchrony in those two developments is worth noting. As HCI reported earlier this month, the U.S. Congress passed, and President Obama signed, legislation eliminating the much-criticized sustainable growth rate (SGR) formula for Medicare physician payment, and within that legislation was contained an overhaul of physician quality reporting programs under Medicare. Interestingly enough, as more and more accountable care programs emerge in U.S. healthcare, with many private-payer programs mimicking some of the core elements of the Medicare program’s ACO programs, over time, the vast majority of U.S. physicians are coming under contract with public and/or private payers that are measuring their outcomes. Now, one of the longstanding complaints about all the various measurement programs out in the industry has been how many there are and how complicated their differing requirements are making life and practice for practicing physicians.

What inevitably seems to be happening here is that some kind of harmonization of outcomes measurement is evolving forward organically. It is still quite nascent; yet it is also clear. As I reported during HIMSS15, the Blue Cross Blue Shield Association’s Blue Distinction Total Care Program is pulling many tens of thousands of practicing physicians into its nationwide umbrella population health program, creating a quality outcomes reporting program within its population health program that could become one of a few dominant such programs in the U.S. private insurer sector.

So the reality is that the long-anticipated harmonization of physician quality reporting emerging both on the public (Medicare) and private health insurer sides of the industry could be starting to come into focus now as we speak. The opportunities coming out of the gradual harmonization of outcomes reporting and measurement efforts across the industry will certainly be a welcomed development for practicing physicians nationwide—and a signal that healthcare quality measurement is reaching a new, more impactful stage.