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Medicare and Insurance Industry Officials Agree on Quality Metrics

By Andrew Siddons, CQ Roll Call

February 16, 2016 -- Public and private health insurance providers on Tuesday announced a new set of quality measurements meant to make reporting requirements for doctors and care providers more consistent and efficient. By easing the reporting complexity for clinicians, insurers are also hoping to bring down costs for themselves and consumers.

While individual payers currently utilize their own measurements, insurers have come together to agree on core measures in seven areas. The effort was led by the Centers for Medicare and Medicaid Services (CMS) and America's Health Insurance Plans, an industry trade group.

"Everywhere you go in healthcare, people ask for universally one thing–simplify, simplify, simplify," Andy Slavitt, the acting administrator for the CMS, said in a telephone briefing Tuesday.

Doctors currently deal with an average of seven or more insurers, each with their own system for measuring performance, according to Douglas E. Henley, the chief executive of the American Academy of Family Physicians. That means health care providers must pay attention to 50 to 100 measures, which "creates a lot of chaos and confusion," he said.

The new core set of 21 measures, "if harmonized across payers, would certainly simplify the life of every family physician," Henley added.

The new measurements will be adopted by CMS as well as many private insurers, ultimately covering around 70 percent of all health care payers. CMS, which already uses some of the new measurements, will begin implementing the rest of the changes, including eliminating redundant measures, through its rulemaking process later this year. Private insurers are expected to phase in the changes starting in 2017.

The core measures announced on Tuesday will be in seven areas, including: primary care; cardiology; gastroenterology; HIV and Hepatitis C; medical oncology; obstetrics and gynecology; and orthopedics.

The measurements are a result of an effort by many organizations, known as the Core Quality Measure Collaborative, and Tuesday's announcement won praise from numerous outside groups.

Carol Sakala, the director of childbirth connection programs at the National Partnership for Women and Families, said that by eliminating time wasted grappling with poorly-aligned measurements, the new measures would help doctors focus on providing high-value care to patients.

"When we ask them to devote precious resources to measurements, it will be for measures that matter," she said.

Groups representing cardiologists, however, pointed out that two measures aimed at patients with hypertension offer different blood pressure control targets. One of the measures is a less strict blood pressure control level tailored specifically to older patients with diabetes or kidney disease. The American College of Cardiology and the American Heart Association groups worry that the two levels might be misinterpreted. "These measures could confuse patients and providers," the groups said in a joint statement.

But the quality measures announced Tuesday can be adjusted as needed, said Slavitt, who encouraged patients and physicians to provide feedback. The collaborative that wrote the measures, he said, "will stay intact to monitor adoption of the measure sets and identify and release new measures that can be added over time."

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