Patient-Centered Payment: NCQA’s Mandate for CMS Measure Development

March 2, 2016 · Amy Maciejowski

The health care payment revolution—yes, revolution—took a huge leap forward last year. Now as this revolution accelerates, NCQA wants to make sure patients—the reason for the revolution—are remembered.

measure development

For years, Medicare calculated its payments to doctors and other providers based on an outdated formula. On top of that, Congress kept that formula in place for years with an annual vote. So year after year, the government paid doctors and other providers based upon how many tasks, treatments and procedures they completed. There were few payment incentives for improving quality.

Last year, Congress changed everything with the Medicare Access and CHIP Reauthorization Act (MACRA). That’s the new law passed by Congress that aims to base payment upon the quality of care, not necessarily the number of procedures. It received praise from organizations, industry leaders, policymakers and doctors. But MACRA’s full implementation is not nearly complete. Tying Medicare payments to value, rather than to volume, will be a long journey— new payment policies won’t begin to take effect until 2019 and the full effect won’t occur until 2023.

NCQA has been working with the Centers for Medicare & Medicaid Services (CMS) to provide insight on the best way to implement MACRA. CMS prepared a draft “Quality Measurement Development Plan (MDP)” to support the transition as we move away from fee-for-service payments and adjust new systems to represent value of care. In our opinion, the draft is a step in the right direction. Our Public Policy team reviewed the plan and submitted comments to CMS, you can view the full comment letter here.

Here’s the short version…

CMS’ strategic vision is a great starting point. We know that measurement must be adaptive and must evolve in order to reach the final destination of higher quality care.

Measurement is not as cut-and-dried as some would hope—but neither is health care. Not every patient has the same symptoms; not every patient reacts to treatments in the same way.

Measures That Matter to Patients

The CMS draft plan includes the development of a patient-centered measure portfolio to address critical measurement gaps. As CMS suggests, measures in a larger portfolio will reflect the underlying complexity of real people, of individual patients and of health care delivery itself. Keeping patient-centered measurement and patient-reported outcome measures adaptive and personalized will give a voice to every patient, not only to the average patient.

More Elements That Matter

The draft plan includes multiple components, in addition to its focus on patient-centered measurement. Our comments highlight details to keep in mind as CMS moves forward:

  • A recent report by the Institute of Medicine urges the health care industry to focus on a small number of measures. Our take: It’s a call for nested measures.
  • Measurement needs to flow naturally from a clinician’s work. Improvements in infrastructure and data collection can make this happen.
  • Why there aren’t more appropriate-use measures.
  • We must eliminate care disparities.

We commend CMS on its draft measure development plan; this plan is a great first step. View NCQA’s entire comment letter here.

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