Measure Prioritization and Planning
CMS responds to a variety of inputs to develop and implement its quality measurement agenda for the next 5 to 10 years. CMS develops and implements quality measures with the primary purpose of improving care in a spectrum of health care service delivery settings such as hospitals, outpatient facilities, physician offices, nursing homes, home health agencies, hospices, inpatient rehabilitation facilities, and dialysis facilities to improve health outcomes and deliver value. Value comes by empowering persons, or patients, to make informed care decisions through increased transparency that is accessible, as well as from reducing burden to measured entities. CMS places emphasis on digital and electronically specified measures for implementation in quality initiatives. The use of these measures include
- Public reporting
- Value-based purchasing
- Other payment incentive and accountability programs
In broad terms and in context of legislative mandates, CMS continues to pursue measure development and maintenance work based on national health care priorities, with an emphasis on outcome- and patient-centered measures. These focus areas drive measure development, selection, and implementation activities. CMS also sets priorities based on inputs from the National Impact Assessment reports. Although the current CMS measurement programs are setting-specific, there is an increasing need to move toward a more patient-centric approach that spans the continuum of care. CMS uses a framework, multiple different reports, and environmental scans to help identify and close important gap areas of measures, align measures across the continuum of care and across payors, and spur innovation in new types of measures such as patient-reported measures and digital measures. CMS programs need and highly prioritize patient-reported outcome measures and measures using patient-generated data.
With the implementation of many quality initiatives, quality measures are proliferating. While measurement gaps still exist, CMS has made significant progress. With the CMS consensus-based entity comprehensive evaluation process, there has been substantial work done to identify “best in class measures” and to harmonize related and competing measures.
- The pre-rulemaking process required under Section 3014 of the Patient Protection and Affordable Care Act requires the CMS CBE to convene interested parties to provide recommendations on the Measures Under Consideration List.
- The 2015 IOM Vital Signs: Core Metrics for Health and Health Care Progress Report and the 2021 National Impact Assessment of the CMS Quality Measures Report findings and actions will further the momentum toward “measures that matter.”