Quality Measures and Federal Policy: Increasingly Important and A Work in Progress. American Health Quality Association Policy Forum Washington, D.C.

Transcription

1 Quality Measures and Federal Policy: Increasingly Important and A Work in Progress American Health Quality Association Policy Forum Washington, D.C. February 9, 2016

2 Quality Journey NCQA Develops Health Plan Report Card President s Advisory Commission NQF launches; IOM To Err is Human IOM, Crossing the Quality Chasm Focus: Public Reporting 2

3 Quality Measures: More Consequential CMS Launches Hospital Compare and Pay for Reporting HITECH Act Passage of the ACA Value-based purchasing and CMMI Measure Applications Partnership (MAP) to align measures for federal programs Focus Shifts: Value-based Purchasing 3

4 Policy: From Volume to Value 4

5 Examples of Federal Programs Using Measures Clinician Level Merit-Based Incentive Payment System (MIPS) Physician Compare Hospital and Facility Level Ambulatory Surgical Center Quality Reporting Program ESRD Quality Incentive Program Hospital Acquired Condition Reduction Program Hospital Compare Inpatient Quality Reporting and EHR Incentive Program Outpatient Quality Reporting Program Hospital Readmissions Reduction Program Hospital Value-Based Purchasing Program Inpatient Psychiatric Facility Quality Reporting Program Prospective Payment System-Exempt Cancer Hospital Quality Reporting Program Post-Acute/Long Term Care Home Health Quality Reporting Program Hospice Quality Reporting Program Inpatient Rehabilitation Facility Quality Reporting Program Long-Term Care Hospital Quality Reporting Program Skilled Nursing Facility Quality Reporting System Skilled Nursing Facility Value-Based Purchasing Program ACO Medicare Shared Savings Program Plan Level Medicare Advantage Star Rating Part D Star Rating 5

6 Policy: From Volume to Value Federal Government VALUE-BASED PAYMENT ALTERNATIVE PAYMENT MODELS Private Payers 6

7 Fewer Measures, But More that Matter >2,000 Total Measures in Use Health Plan Measures State Measures Institutional Measures Ratings 7

8 NQF Strategies: More Measures that Matter 8

9 NQF Strategies Measure Endorsement and Selection Importance Scientific Rigor Feasibility Usability Harmonization and Selection of Best-in-Class 9

10 Tensions in Measurement 10

11 NQF Strategies Measurement Science Evidence Gaps in care Attribution Adjustment for socio-economic factors Burden e-measures Feedback Impact Alignment Comparability Intended Use 11

12 SES Adjustment: Two Divergent Views Adjustment for SES necessary for comparative performance Adjustment for SES will mask disparities 12

13 NQF SES Trial Period Standing Committees working with developers to assess if SES adjustment is appropriate for each measure Not all outcomes should be adjusted for SES factors (e.g., central line infection would not be adjusted) Need conceptual basis (logical rationale, theory) and empirical evidence Full transparency and evaluation of trial period Launched Disparities Committee to review implementation and evaluate SES pilot. Committee will focus on how measurement can proactively reduce disparities 13

14 Begin Addressing the Attribution Challenge Ideally accountable entities are linked to patient outcomes and payment What is under the control of the provider? Commissioned paper: Environmental scan of approaches to attribution; assess strengths and weaknesses Develop guiding principles for attribution Recommendations to guide the selection and implementation of various models of attribution Projected to be completed by the end of

15 NQF Members: Quality is a Team Sport 15

16 Making Care Safer and Reducing Costs Between

17 Making Care Better and Reducing Costs 17

18 Technical Assistance to Policymakers In addition to endorsement, selection and measurement science, NQF provides technical assistance to Congress: IMPACT HIT HELP HIT bill, telehealth Medicaid Chronic Care Working Group Rural health 18

19 Measurement Involves Everyone 19