CMS Quality Measure Development Plan Supporting the Transition to the Merit-Based Incentive Payment System (MIPS)  and Alternative Payment Models (APMs)

By: Kate Goodrich, M.D., M.H.S., Director, Center for Clinical Standards & Quality, CMS

Today we’re continuing to shift Medicare payments from volume to value by posting our draft Quality Measure Development Plan [https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html]. The Measure Development Plan is a strategic framework for future clinician quality measurement development.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) further supports the path to value in health care with the new Merit-based Incentive Payment System (MIPS) and incentives for providers to participate in alternative payment models (APMs).

To accelerate the alignment of quality measurement and program policies, MACRA sunsets payment adjustments for three existing clinician reporting and incentive programs:

  • Physician Quality Reporting System (PQRS).
  • Value-based Payment Modifier (VM).
  • Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), commonly known as Meaningful Use.

The Measure Development Plan outlines how we’ll draw from our quality measure development experience to build a measure portfolio for MIPS and APMs. Existing measurement strategies, policies, and principles will guide our efforts.

The Measure Development Plan focuses on gaps we identified in the quality measure sets currently in use in PQRS, VM, and the EHR Incentive Program and offers recommendations for filling these gaps. Future measure development will prioritize person- and caregiver-centered experience of care, patient-reported outcomes and patient health outcomes, communication and care coordination, and appropriate use of resources across six quality domains:

  1. Clinical Care.
  2. Safety.
  3. Care Coordination.
  4. Patient and Caregiver Experience.
  5. Population Health and Prevention.
  6. Efficiency and Cost Reduction.

In addition, these measures will promote efficient data collection, better ensure provider accountability—individual and shared, and yield publicly reported quality results that consumers can use to make informed health care decisions.

The Measure Development Plan describes how CMS will work collaboratively with federal and state partners and private payers to create an aligned set of measures that reduces provider burden.  The plan also describes resources and activities that can contribute to the development of measures applicable to a wide variety of stakeholders.

As our portfolio of measures evolves, we will continue to seek input on the draft plan and its stated priorities from clinicians, payers, patients, caregivers, and other stakeholders. We’ll review and consider all comments we receive as we develop the final Measure Development Plan, which we will post by May 1, 2016.

The  Measure Development Plan directly supports the implementation of MIPS and APMs and your input is important to us. These programs move the Medicare program and our overall health care system toward paying for the quality rather than the quantity of care delivered to patients.

We encourage you to read the Measure Development Plan and send us your comments, questions or thoughts by March 1, 2016, either online [https://www.surveymonkey.com/r/26NYQRB]; via the MDP dedicated email address [MACRA-MDP@hsag.com]; or by U.S. mail [Attn: Eric Gilbertson, CMS MACRA Team; Health Services Advisory Group, Inc.; 3133 East Camelback Road, Suite 240; Phoenix, AZ 85016-4545].

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