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NQF Offers Guidance for MIPS, Other Federal Healthcare Programs

March 23, 2016
by Rajiv Leventhal
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The National Quality Forum (NQF) has released guidance on measures under consideration for the new Merit-Based Incentive Payment System (MIPS) while also calling for the alignment of measures across multiple federal healthcare programs.

NQF’s Measure Applications Partnership (MAP) considered 60 performance measures for use in MIPS, a Centers for Medicare & Medicaid Services (CMS) program legislated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MIPS combines the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare electronic health record (EHR) incentive program into a single program that will adjust eligible providers’ Medicare payments based on performance. The MIPS measures that MAP reviewed were proposed for potential implementation in 2017 in order to collect data for use in the MIPS program in 2019. Given the tight window, healthcare leaders are anxiously waiting for further proposed rules for MACRA/MIPS to come out; CMS has set the expectation that this will be coming sometime this spring.

What’s more, according to a Quality Measure Development Plan (MDP) released by CMS late in 2015, MACRA identifies five quality domains (i.e., clinical care, safety, care coordination, patient and caregiver experience, population health and prevention) for measures developed under the MDP, which aims to serve as a strategic framework for the future of clinician quality measure development. CMS is required to enter into contracts for the purpose of developing, improving, updating, or expanding its measure development plan, and must publish an annual report with progress made during each year, including a listing of the new measures developed. And related to alignment of quality measures, CMS and America’s Health Insurance Plans (AHIP), in collaboration, for the first time, just recently released seven sets of standardized clinical quality measures for physician quality programs that support multi-payer alignment. 

As such, MAP noted the following guidance to the U.S. Department of Health and Human Services (HHS):

  • Alignment of measures across federal programs is a priority, and it will be important for CMS to pursue alignment of quality measures across the MIPS program and alternative payment models (APMs) such as CMS’ Medicare Shared Savings Program (MSSP), as well as alignment with states and the private sector where possible.
  • Measure gaps remain across clinician-level programs, especially in patient-centered areas such as patient-reported outcomes, functional status, and care coordination. According to MAP, patient-focused measures should go beyond patients’ experience with the healthcare system to the impact of healthcare on patients’ health and well-being.
  • The impact of patients’ socioeconomic status (SES) and other demographic factors on measure results should continue to be explored, and it is important to take into account whether providers are caring for high-risk populations. MAP noted support for NQF’s two-year trial period examining the impact of SES adjustment on measurement.

According to the guidance, “In pursuit of consistency, parsimony, and reducing the burden of measurement and reporting, MAP has identified alignment of measures across federal programs as one of its most important cross-cutting priorities. Alignment, or use of the same or related measures, is a critical strategy for accelerating improvement in priority areas, reducing duplicative data collection and enhancing comparability and transparency of healthcare information. MAP assesses and promotes alignment of measurement across federal programs and between public- and private-sector initiatives to streamline the costs of measurement and focus improvement efforts. One of the principles guiding MAP’s work is that, to the extent possible, the same measures should be used across different programs and should be defined in the same way (unless there are justifiable reasons for differences).”



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