A pledge was made at the National Quality Forum eMeasure Learning Collaborative’s “Best Practices in eMeasure Implementation” meeting on April 26 to align the close to 1,000 eMeasures that are now being used for various quality reporting programs. The sheer amount and complexity of eMeasures for quality measurement have long been a thorn in the side of providers and challenge industry-wide.
“We hear a lot from providers that we have too many measures, and we would agree,” said Kate Goodrich, senior technical advisor in the Centers for Medicare & Medicaid Services’ Office of Clinical Standards & Quality. “We need to balance that goal of parsimony with having enough measures within certain programs to address all of our specialties out there.”
Quality measurement at the point of care has been a long time coming, and many naïve optimists years ago underestimated the difficulty of this, said Farzad Mostashari, M.D., national coordinator for health information technology, ONC.
“Many of us have learned painful lessons about just how damn hard it is to change systems when you’re only holding one part of it,” Mostashari said. “Trying to change practice without changing payment, trying to change payment without having information tools and delivery systems to be able to carry that [is difficult]. But the good news is that we are now uniquely at a time and a place where those strands are actually coming together.”
Farzad Mostashari, M.D.
Mostashari said the ONC was using its convening role to accelerate consensus among the various stakeholders to overcome challenges to collaborate on performance measurement. Mostashari also advocated, as he’s done publicly many times before, for the industry to keep its “eye on the prize,” and focus on what matters. He said the industry had lost focus by not developing measures for key healthcare problems. For instance, he cited the need to develop measure to gauge appropriate dosages of the blood thinner Coumadin; overdosing of that medication is the No. 1 cause of avoidable ED visits for elderly patients. He also decried the fact the industry had yet to create a measure for care coordination and closing the referral loop.
Goodrich said that senior representatives from across CMS were uniting to create a Quality Measures Task Force to align and prioritize measures across programs, as well as aligning them with the National Quality Strategy and avoid duplication or conflict among developing and implementing measures. CMS is focusing on six domains for quality measurement: clinical care, care coordination, population health, cost reduction, safety, and person/caregiver experiences and outcomes.
“Our goal is to get to a place where in all of our programs, we have core sets of measures that cross all these domains,” said Goodrich. “We definitely are not there yet because of the problem we have with measure gaps, but that is our goal.”
Goodrich admitted that alignment would take considerable time, given that the Task Force evaluates all measures in programs on a measure-by-measure basis during the yearly rule-making cycle, based on criteria for inclusion in programs, removal from programs, and alignment across programs.
Another goal for CMS is measuring performance at the community, practice setting, and individual physician levels. To aid in this objective, CMS plans to leverage opportunities to align with the private sector. “This is a focus for us for this upcoming year with the work of the measures application partnership to really get our hands dirty and figure out how to align with the private sector,” Goodrich said.
Goodrich also noted that a recently established sub-group of HHS National Quality Strategy group, the HHS Measurement Policy Council, will focus on measure alignment across the department.
“Very importantly for this group, besides just plain alignment of measures, I think is to establish operationalized measurement policies related to measurement implementation and measure development and getting back to trying to reduce measure burden and duplication of efforts,” she said.