CMS Quality Strategy and Quality Measurement

AHA Annual MeetingDr. Patrick Conway, M.D., MSc CMS Chief Medical Officer and Deputy Administrator for Innovation and QualityDirector, Center for Medicare and Medicaid innovationDirector, Center for Clinical Standards and Quality

May 5, 2014

The Six Goals of the CMS Quality Strategy

Make care safer by reducing harm caused in the delivery of care

Strengthen person and family engagement as partners in their care

Promote effective communication and coordination of care

Promote effective prevention and treatment of chronic disease

Work with communities to promote healthy living

Make care affordable

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CMS framework for measurement maps to the six national priorities

Greatest commonality of measure concepts across domains

– Measures should be patient-centered and outcome-oriented whenever possible

– Measure concepts in each of the six domains that are common across providers and settings can form a core set of measures

Person- and Caregiver- centered experience and

engagment

•CAHPS or equivalent measures for each settings•Shared decision-making

Efficiency and cost reduction

•Spend per beneficiary measures•Episode cost measures•Quality to cost measures

Care coordination

•Transition of care measures•Admission and readmission measures•Other measures of care coordination

Clinical quality of care

•HHS primary care and CV quality measures•Prevention measures•Setting-specific measures•Specialty-specific measures

Population/ community health

•Measures that assess health of the community•Measures that reduce health disparities•Access to care and equitability measures

Safety

•Healthcare Acquired Infections•Healthcare acquired conditions• Harm

CMS Quality Strategy: Foundational Principles

Eliminate disparities

Strengthen infrastructure and data systems

Enable local innovations

Foster learning organizations

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CMS Vision for Quality Measurement

• Align measures:– With NQS and 6 measure priorities/domains.– With external stakeholders (private payers, states)– Across CMS programs whenever possible

• Create parsimonious or cores measure sets• Implement measures filling critical gaps

(patient-reported outcomes, care coordination, appropriate use, etc.) in rapid cycle

• Remove “topped-out” measures.• Goal is improvement over time 5

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Future Hospital Quality Measurement

• Robust quality measures covering the 6 goals from the CMS Quality Strategy

• Adopt Quality Measurement across care settings

• Integrated quality reporting and pay-for-performance programs

• Submit once and fulfill multiple quality programs

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Hospital Value Based Purchasing

• Additional stakeholder input– Pre-rulemaking process to allow stakeholders to submit

measure concepts and given input– Enables CMS to more quickly target measurement goals

identified in Quality Strategy• Evolution of Quality Measures/Domains

– Expanding measures’ focus to outcomes, patient experience and efficiency

– New quality domains for FY 2017 based on Quality Strategy

– Monitoring and evaluation efforts ongoing

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Hospital Readmission Reduction Program

• 5 condition specific measures– AMI, HF, PN, COPD, THA/TKA

• Strive to be parsimonious– All Cause Hospital Wide Readmissions (HWR)

measure• Stakeholder support for this measure recognized by

CMS• Likely lack statutory authority to implement measure

as currently designed.

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Hospital Acquired Conditions Reduction Program

• FY 2017: 5 Hospital Associated Infections will be implemented in addition to PSI-90– CLABSI, CAUTI, SSI, MRSA, C. difficile

• FY 2015 IPPS/LTCH PPS proposed rule– Seeking stakeholder input on electronically

specified measures of all-cause harm

Future State for CMS Programs

• Improve quality of care using:– Robust quality measures.– Timely feedback to providers.– EHR’s in a meaningful manner.

• Minimize reporting burden by:– Synchronizing performance and reporting periods.– Reduce number of required submissions by professionals for

eCQM data to one.• Maximize efficiency by:

– Using eCQM reported data for multiple quality programs.

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The Future of Quality Measurement for Improvement and Accountability• Meaningful quality measures increasingly need to transition

away from setting-specific, narrow snapshots• Reorient and align measures around patient-centered outcomes

that span across settings• Measures based on patient-centered episodes of care• Capture measurement at 3 main levels (i.e., individual clinician,

group/facility, population/community)• Example gaps areas to be filled: patient reported outcomes, care

coordination, patient engagement, efficiency, etc• Why do we measure?

– ImprovementSource: Conway PH, Mostashari F, Clancy C. The Future of Quality Measurement for Improvement and Accountability. JAMA 2013 June 5; Vol 309, No. 21 2215 - 2216

Contact Information

Dr. Patrick Conway, M.D., M.Sc.CMS Deputy Administrator for Innovation and Quality and

CMS Chief Medical Officer 410-786-6841

patrick.conway@cms.hhs.gov

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