CMS releases its Measures Under Consideration List for 2018 pre-rulemaking

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

Medicare and other payers are rapidly moving toward a healthcare system that rewards high quality care while spending more wisely. Foundational to the success of these efforts is having quality measures that are meaningful to patients, consumers, and providers alike.  CMS recently announced the “Meaningful Measures” initiative to identify the most impactful areas for quality measurement and improvement and reflect core issues that are most vital to high quality care and better individual outcomes. Each year, CMS publishes a list of quality and cost measures that are under consideration for Medicare quality reporting and value-based purchasing programs, and collaborates with the National Quality Forum (NQF) to get critical input from multiple stakeholders, including patients, families, caregivers, clinicians, commercial payers and purchasers, on the measures that are best suited for these programs. Ultimately, these measures may help patients choose the nursing home, hospital, or clinician that is best for them, and can help providers to provide the highest quality of care across care settings.

I am happy to announce that CMS posted the Measures under Consideration (MUC) List for 2018 pre-rulemaking on the CMS website and has sent it to NQF in preparation for multi-stakeholder input.

This year’s MUC List contains 32 measures that have the potential to drive improvement in quality across numerous settings of care, including clinician practices, hospitals, and dialysis facilities. CMS is considering new measures to help quantify healthcare outcomes and track the effectiveness, safety and patient-centeredness of the care provided.  At the same time, CMS is taking a new approach to coordinated implementation of meaningful quality measures focused on the most critical, highly impactful areas for improvement while reducing the burden of quality reporting on all providers so they can spend more time with their patients.  In addition to other factors, CMS evaluated the measures on the MUC list to ensure that measures considered for adoption in a CMS program through rulemaking as necessary, focus on clearly defined, meaningful measure priority areas that safeguard public health and improve patient outcomes.  For example, to generate this year’s MUC list, CMS considered 184 measures submitted by stakeholders during an open call for measures.  Considering the meaningful measurement areas, CMS narrowed the list to 32 measures (17% of the original submissions) which focus CMS efforts to achieve goals of high quality healthcare and meaningful outcomes for patients, while minimizing burden. CMS will continue to use the Meaningful Measures approach to strategically assess the development and implementation of quality measure sets that are the most parsimonious and least burdensome, that are well understood by external stakeholders, and are most likely to drive improvement in health outcomes.

This year, approximately 40% of measures on the MUC list are outcome measures, including patient-reported outcome measures, which will help empower patients to make decisions about their own healthcare and help clinicians to make continuous improvements in the care provided. In addition, this year there are eight episode-based cost measures proposed that were developed by incorporating the insight and expertise of clinicians and specialty societies.  CMS is committed to working with clinicians, consumers, and other stakeholders on the development and use of measures that are most meaningful to patients and clinicians and our programs.

We invite you to review the MUC List in detail and to participate in the public process. We believe it is critical to hear a wide range of voices in the selection of quality and efficiency measures that are used for accountability and transparency purposes and look forward to another successful pre-rulemaking season. For more information regarding the NQF Measure Applications Partnership public stakeholder review meeting purpose, meetings, 2017 MUC List deliberations and voting, visit the NQF website at http://www.qualityforum.org/map/.

CMS announces a new user-centered resource to help improve alignment: the CMS Measures Inventory Tool (CMIT)

By Kate Goodrich, MD
Director, CMS Center for Clinical Standards and Quality & CMS Chief Medical Officer

CMS is actively working to move the needle on improving quality in healthcare without additional burden to those providers on the frontlines. CMS recently launched a new initiative, ‘Meaningful Measures,’ which will streamline current measure sets – so providers can focus on the measures that are most impactful – and will move from process measures to outcome measures where possible. A great deal of attention has also been focused on alignment of quality measures within CMS and with commercial payers, and we are committed to working towards alignment of these measures to ensure delivery of high quality care to all Americans while minimizing burden on providers.

I am pleased to announce that CMS is deploying an innovative tool that provides all stakeholders improved visibility into the portfolio of CMS measures. The CMS Measures Inventory Tool (CMIT), an interactive web-based application that contains the same information that is currently included on the  Excel spreadsheet, provides a comprehensive list of measures that are currently under development, implemented for use, and have been removed from a CMS quality program or initiative.  The intuitive and user-friendly functions allow you to find measures quickly and to compile and refine sets of related measures. The tool increases transparency and can be used to identify measures across the continuum of care and will help coordinate measurement efforts across all conditions, settings, and populations.  We have expanded the information contained in the inventory to better answer questions we have heard from the public; the CMIT lists each measure by program, dates of measure consideration and implementation, and measure specifications including, but not limited to, numerator, denominator, exclusion criteria, measure type, and National Quality Forum (NQF) endorsement status.

CMIT is an innovative approach that will help to promote the goal of increased alignment across programs and with other payers.  We believe it is an easy to use valuable resource to various stakeholders, including commercial payers, clinicians, patients and measure developers.

For more information about CMIT and to access the tool, please visit the CMS.gov website.

Administrator’s Blog: National Rural Health Day (November 16, 2017)

November 16, 2017

By: Seema Verma, CMS Administrator @SeemaCMS 

Today, CMS is celebrating National Rural Health Day by commemorating our partners who provide quality care to the nearly one in five Americans who reside in rural communities. CMS recognizes the unique challenges facing rural America, and we are taking action to improve access and quality for healthcare providers serving rural patients.

This fall, I have been visiting communities throughout the country to learn more about issues critical to improving access to rural healthcare. I travelled to Kansas City and visited the headquarters of the National Rural Health Association to talk with key leadership and stakeholders to hear how CMS can reduce the challenges rural communities face. CMS is committed to evaluating our policies and looking at each of them through a rural lens to ensure rural providers greater flexibility and less regulatory burden.

New technologies are emerging that have strong promise to address access issues in rural communities. CMS is trying to modernize the Medicare program so that beneficiaries can make use of the new technology. For example, CMS recently released new telehealth payment codes in Medicare so more services can be accessed in rural areas. This is only the beginning of our overall strategy to update our programs and improve access to high quality services.

Rural hospitals also face challenges in recruiting physicians. CMS is addressing this challenge by placing a two-year moratorium on the direct supervision requirement for outpatient therapeutic services at Critical Access Hospitals and small rural hospitals. This policy helps to ensure access to outpatient therapeutic services for Medicare beneficiaries living in rural communities and provides regulatory relief to America’s small rural hospitals. In Medicare Advantage plans, we are working to ensure network standards offer the flexibility needed to provide greater health care plan choices to rural beneficiaries. These reforms are in line with our focus on improving the beneficiary experience.

In response to feedback received from Critical Access Hospitals and other rural stakeholders, CMS recently announced that Critical Access Hospitals should no longer expect to receive medical record reviews related to the 96-hour certification requirement absent concerns of probable fraud, waste, or abuse. 

We are also now providing technical assistance and greater flexibilities to small and rural clinicians to help facilitate their participation in the Quality Payment Program (QPP). These efforts are aligned with our goal of reducing regulatory burden so clinicians are able to spend more time on patient care and healthier outcomes, and less time on paperwork. One way we have done this is to provide free and customized technical assistance to support small and rural clinicians every step of the way, as well as assistance through our Service Center, Regional Offices, and the QPP page on cms.gov.

We have finalized several policies to reduce burdens and help clinicians in small practices successfully participate in the QPP program. Some of these include:

  • Increasing the “low volume threshold,” which is the maximum amount of Medicare revenue and the maximum number of Medicare patients that a clinician can have while being excluded from the new requirements, to exclude more small practices from QPP.
  • Adding an option for clinicians to come together in “virtual groups” to report data together and share the burden of meeting the new requirements.
  • Continuing to award small practices a minimum of three points for quality measures, recognizing that small practices may not be able to pull together the amount of data as easily as large practices.
  • Providing small practices with a new hardship exception to some of the EHR reporting requirements.
  • Adding five bonus points to the final performance score for small practices.

In our effort to consider a new direction that promotes patient-centered care and test market-driven reforms, the CMS Innovation Center is currently seeking suggestions on improving rural healthcare by way of a recently released Request for Information (RFI). The opportunity to provide recommendations for the new direction closes November 20 and if you have not already, we hope you will share your thoughts.

CMS has also developed a number of resources to help rural providers and other stakeholders.  To improve the customer experience and further empower our rural providers, we are centralizing rural healthcare resources into a single website which you can find here.

And finally, CMS does not operate in a vacuum.  We work closely with other federal partners including the Health Resources and Services Administration, the Office of the National Coordinator, and the Centers for Disease Control and Prevention, among others, to ensure our efforts to improve care in rural America are consistent with those agencies’ rural initiatives. CMS will continue to listen to, work with, and value the input from rural stakeholders.  Together, we can improve care in rural America.  Happy National Rural Health Day!

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National Minority Health Month: Bridging Observance and Action to Achieve Health Equity

By Cara V. James, PhD, Director, CMS Office of Minority Health 

Each April we observe National Minority Health Month. This year’s theme is, Bridging Health Equity Across Communities. This theme acknowledges the important role that social determinants of health play in individual and community well-being. It also evokes action and activity  around health equity. For it is not enough for us to simply observe National Minority Health Month and share statistics on long-standing health and health care disparities. We should strive to move the needle by reducing these disparities and improving health care quality and outcomes for all. As this National Minority Health Month comes to a close, we still have work to do, and I’m hoping each of us can take a moment and consider the following question:

What will it take to achieve health equity?

CMS has adopted a health equity framework that focuses on increasing understanding and awareness of disparities, developing and disseminating solutions, and implementing sustainable action. As we have sought to implement this framework, we have identified a number of areas that need to be considered when addressing a specific disparity– the social determinants of health, data, and the seven “A’s”.
First and foremost, we need to acknowledge there is a problem to be addressed. We need to agree on the goal and identify what resources will be necessary to meet it. Resources can be difficult to come by, so determining how the goal aligns with existing priorities may be key. Next we must decide what actions do we need to take to achieve our goal? Are we already doing some or all of them?

Seven A’s for Addressing Health Equity

  1. Acknowledge there is a problem to be addressed.
  2. Agree on the goal, and identify what resources are necessary to meet it.
  3. Align the goal with existing priorities.
  4. Determine what actions are needed to achieve the goal.
  5. Create alliances to implement the actions.
  6. Analyze progress, and adjust the plan as necessary.
  7. Have shared accountability for reaching the goal.

 

We know that health equity cannot be achieved by a single individual or organization, so forging alliances and working together is critical. We also know that we must be able to measure our progress. Having data and doing analysis of it are important for the development, assessment, and revision of our health equity plan. The last of the A’s requires us to be accountable and ask the question – what happens if we do not reach our goal? There shouldn’t be one person or organization responsible for the success or failure of a plan, but a shared accountability.

While we are considering each of the seven A’s, we must also consider the myriad of social factors that influence health and well-being of individuals and the communities in which they reside. Whether we refer to them as social risk factors or social determinants of health, we know that things such as socioeconomic position, race, ethnicity, cultural context, gender, social relationships, and residential and community context affect our health more than the care we receive from our health care providers. We must consider these factors as we think about our goals, the actions we need to take, and the alliances we forge.

The CMS Office of Minority Health is helping to embed these actions across CMS and HHS. For example, we routinely share HEDIS and CAHPS quality measures stratified by race, ethnicity, and gender, providing health plans with actionable data to innovate and prioritize health equity and quality improvement activities. Organizations participating in the Accountable Health Communities Model will be montoring disparities as they link beneficiaries with commmunity services. We are working with our sister agency, the Health Resources and Services Administration’s, Federal Office of Rural Health Policy on a Chronic Care Management Education and Outreach Campaign. The campaign is focused on professionals and consumers in underserved rural areas, and racial and ethnic minorities. We are also collaborating with organizations outside the federal government to help reduce readmissions among racially and ethnically diverse beneficiaries, and to develop their own plans for achieving health equity.

As we continue on our path to equity, we encourage you to consider the seven A’s, the role of social risk factors, and the importance of data in your day-to-day activities. Recommit every day to the ultimate goal of achieving health equity by bridging observance and action during the remainder of National Minority Health Month and throughout the year.

To learn more about achieving health equity and other activities underway at the CMS Office of Minority Health, visit: go.cms.gov/omh. 

CMS’ Ongoing Commitment to Minority Health

April 26, 2017

By: Seema Verma, Administrator, Centers for Medicare & Medicaid Services (CMS)

As many of you know, April is National Minority Health Month, and it’s a privilege to be Administrator at the Centers for Medicare & Medicaid Services (CMS) and take part in the observance. This year’s theme is “Bridging Health Equity Across Communities”. At CMS we have an extraordinary opportunity to improve health outcomes for the over 100 million people that we serve every day. Our primary mission is to make healthcare accessible and affordable for all Americans.

During this important month, we continue our efforts to raise awareness about disparities, and provide tools and resources to support actions to address them. In addition to our ongoing work to address these disparities through efforts like the CMS Equity Plan for Improving Quality in Medicare, the CMS Office of Minority Health released new Medicare Advantage (MA) data on racial and ethnic disparities in care. The data helps us understand the connections between a person’s race, ethnicity, and gender and the health care that they receive.

Two new reports focus on the treatment and patient care experiences for a variety of conditions. The first report looks at racial and ethnic disparities by gender and examines differences between black, Hispanic, Asian and Pacific Islander and white MA beneficiaries in rates of colorectal cancer screening, treatment for chronic lung disease and other conditions as well as their ability to access needed care.

The second report looks at gender differences in access to care and quality of treatment for certain conditions among MA beneficiaries. It shows that women receive better treatment for chronic lung disease and rheumatoid arthritis and are more likely than men to receive proper follow-up care after being hospitalized for a mental health disorder.

This tremendous research can only point out the problems. We need healthcare professionals, stakeholder organizations, researchers, and community groups to use these CMS reports, along with our other tools and resources, to develop interventions for racially and ethnically diverse Medicare beneficiaries. 

Through transparency, flexibility, and innovation, we will use every available tool to improve the Medicare program and promote the availability of high value and efficiently-provided care for all beneficiaries. We do this, by working together with plans, providers and the patients we serve to find ways to reduce the disparities highlighted in these reports and find effective health solutions that work for all communities and all Americans.

 

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Supporting Comprehensive and Innovative Care for Children: Request for Information on a Potential Pediatric Alternative Payment Model

February 27, 2017

By Patrick Conway, M.D., M.Sc., Acting Administrator, Centers for Medicare & Medicaid Services; Deidre Gifford, M.D., M.P.H., Deputy Director, Center for Medicaid and CHIP Services; Ellen-Marie Whelan, N.P., Ph.D., Chief Population Health Officer, Center for Medicaid and CHIP Services; and Alex Billioux, M.D., D.Phil., Director, Division of Population Health Incentives and Infrastructure, Center for Medicare & Medicaid Innovation

In partnership with states and providers, the Centers for Medicare & Medicaid Services (CMS) plays a leading role in safeguarding the health of America’s future by providing coverage for more than one in three American children[1]. Through Medicaid and the Children’s Health Insurance Program’s (CHIP) mandatory and optional benefits, children receive access to a spectrum of comprehensive and preventive health care services aimed at providing a sound start for lifelong health. As a result, children enrolled in Medicaid and CHIP lead the nation in participation in preventive care and access to needed care[2].

CMS and states have also demonstrated consistent commitment to improving the health of children through care redesign and innovation in programs such as Medicaid Health Homes, the Medicaid Innovation Accelerator Program, and models tested under the Center for Medicare and Medicaid Innovation (Innovation Center), including the State Innovation Models Initiative and Strong Start for Mothers and Newborns Initiative. To build on those efforts, the Innovation Center, in partnership with the Center for Medicaid and Chip Services (CMCS), is releasing a Request for Information (RFI) today seeking input on the design of alternative payment models focused on improving the health of children and youth covered by Medicaid and CHIP. As the insurer of a third of the nation’s children and a leader in health care innovation, CMS is uniquely positioned to improve the health of America’s children.

We know there is more to health than health care alone, and for children, factors such as sound nutrition, safe living environments, responsive adult caregivers, and nurturing social relationships are especially critical for healthy growth and development. Inadequate or inconsistent access to these factors can have physical and behavioral impacts that reverberate throughout a child’s life course as he or she grows into adulthood. Some children and youth enrolled in Medicaid and CHIP, especially those that are high-need and high-risk, may experience barriers to accessing the optimal combination of child-focused programs and services that are available to address these critical factors. Through the RFI, we are seeking input on approaches to improve the quality and reduce the cost of care for children and youth enrolled in Medicaid and CHIP. In particular, we are exploring concepts that encourage pediatric providers to collaborate with health-related social service providers (e.g., early childhood development programs, child welfare services, and home and community based service providers) at the state and local levels and share accountability for health outcomes for children and youth enrolled in Medicaid and CHIP.

CMS seeks input through the RFI from the broad community of child and youth-focused stakeholders on concepts critical to addressing the comprehensive health needs of children and youth, such as:

  • Opportunities and impediments to extending and enhancing integrated service model concepts like accountable care organizations (ACOs) to the pediatric population;
  • Flexibilities and supports states and providers may need in order to offer such models of care to a state’s pediatric population; and
  • Approaches for states and providers to coordinate Medicaid and CHIP benefits and waivers with other health-related social services for children and youth.

Investing in child health can provide lifelong benefits and improve the nation’s health. We look forward to front-end comments from our state partners and other stakeholders who share our dedication to improving the health of our nation’s children.

For more information on the RFI, please visit: https://innovation.cms.gov/initiatives/pediatric-apm. To be assured consideration, RFI comments must be received by April 7, 2017.

[1] Department of Health and Human Services. 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP. February, 2016. https://www.medicaid.gov/medicaid/quality-of-care/downloads/2015-child-sec-rept.pdf

[2] See CHIPRA Mandated Evaluation of the Children’s Health Insurance Program: Final Findings, available at

http://www.mathematica-mpr.com/~/media/publications/pdfs/health/rpt_chipevaluation.pdf; Kreider AR, French B, Aysola J, Saloner B, Noonan KG, Rubin DM. Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families. JAMA Pediatr. 2016;170(1):43-51. doi:10.1001/jamapediatrics.2015.3028

 

CMS releases its Person and Family Engagement Strategy

By: Kate Goodrich, MD MHS, Director, Center for Clinical Standards and Quality, CMS

At the Centers for Medicare & Medicaid Services (CMS), we are working with numerous partners to transform our health care delivery system to one that delivers better health outcomes while spending dollars more wisely. In November of 2015, we updated the CMS Quality Strategy, incorporating the ongoing work to shift Medicare from paying for the number of services provided to paying for better outcomes for patients. We know that a key strategy to achieving better outcomes is to meaningfully engage patients as partners in decisions about their health care. Therefore, one of the six goals outlined in this strategy is: Strengthen person and family engagement as partners in care. Today, we are excited to announce the release of the CMS Person and Family Engagement Strategy, which we believe can lead to significant progress toward this important goal.

What does person and family engagement mean? We view this as patients and families being part of the health care team by working collaboratively with their doctor or other health care professional to be active partners when making decisions about their health.

Why is this important? Because consideration of the health, values, and goals of the individual in consultation with the entire health care team leads to an improved experience and better care. When people feel responsible for their own health and are partners with their providers in goal-setting and decision-making, they are much more likely to achieve their health care goals.

  • If individuals feel their beliefs, desires, and culture are considered in their care, they are more likely to follow their care plan.
  • If individuals are able to communicate effectively with their providers and have a prominent role in making health care decisions, they will receive better care, can more effectively manage their health, and may receive appropriate preventive care while relying less on emergency or urgent care[1].

The CMS Person and Family Engagement Strategy will serve as a guide for the implementation of person and family engagement principles and strategies throughout CMS programs. This strategy will expand the awareness and practice of person and family engagement by providing the following goals and objectives:

  • Goal 1: Actively encourage person and family engagement along the continuum of care within the broader context of health and well-being in the communities in which people live.
  • Goal 2: Promote tools and strategies that reflect person and/or family values and preferences and enable them to actively engage in directing and self-managing their care.
  • Goal 3: Create an environment where persons and their families work in partnership with their health care providers to develop their health and wellness goals informed by sound evidence and aligned with their values and preferences.
  • Goal 4: Develop meaningful measures and tools aimed at improving the experience and outcomes of care for persons, caregivers, and families. Also, identify person and family engagement best practices and techniques in the field that are ready for widespread scaling and national integration.

This Strategy emphasizes that person and family engagement goes beyond informed consent. It is about including the patients voice in policy and program planning. It is about proactive, effective communication and partnered decision-making with patients, families, and caregivers. It is about building a care relationship based on trust and inclusion of patients’ beliefs, values, preferences, and culture which can even lead to a reduction in health care disparities. Health care decision-making should not always be limited to the patient and provider. It is essential to include family members, care-givers, and close friends in the conversation about health when the patient desires inclusion of others. As delivery system reform efforts move the nation to focus on the quality of care and not the quantity of care received, person and family engagement is an essential part of a health care system that delivers high quality care, spends dollars more wisely, and improves the health of people in their communities.

[1] Epstein RM, Street RL, Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. National Cancer Institute, NIH Publication No. 07-6225. Bethesda, MD, 2007.

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