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AHA: MAP Must Advocate for Streamlined CQMs, Care Improvement

An HHS advisory partnership needs to focus on streamline clinical quality measures aimed at improving patient care and reducing provider workload.

By Sara Heath

The Measure Applications Partnership (MAP), a subgroup under the National Quality Forum, needs to advocate for more streamlined clinical quality measures (CQMs) that improve care value for patients while alleviating burden for providers, says the American Hospital Association.

In a letter to MAP co-chairs Charles N. Kahn and Harold Pincus, MD, AHA explains that as a guiding coalition for stakeholders in HHS, MAP must advocate for better streamlined CQMs to improve care quality.

“The MAP process has yet to realize the promise of identifying ‘measures that matter,’” says AHA Senior Vice President for Public Policy Analysis and Development Ashley Thompson. “As a result, the MAP considers and often supports an excessive number of measures unmoored to any priority areas and lacking evidence demonstrating that their use will enhance the quality of care.”

Specifically, AHA cautions against valuing electronic clinical quality measures (eCQMs) over others considering the burden these measures may place on providers.

“The AHA continues to be concerned about the burden of reporting eCQMs,” Thompson says. “While theoretically these measures should reduce the effort entailed in manual chart abstraction, introducing additional or converting existing measures to be eCQMs incorrectly assumes that the measures work as intended and that all electronic health record (EHR) products support the reporting of those measures.”

AHA states that evidence shows that hospitals do struggle to obtain eCQMs and that they often have to employ significant workarounds in order to collect them.

Additionally, lacking EHR interoperability remains an obstacle for providers collecting eCQMs.

“Many of the quality reporting programs discussed at the MAP workgroup involved sites of care that are not required to or typically do not have fully interoperable EHR systems,” Thompson explains.

“Because of questions concerning the feasibility and accuracy of eCQMs, the AHA urges restraint in adding or converting measures into eCQMs.”

AHA likewise recommends MAP not advocate for any duplicative measures that are on the Measures Under Consideration (MUC) list, stating that they will likely increase provider workload without adding any value in patient care.

Many of the duplicative measures on the MUC list are simple checkbox measures, AHA contends, aimed at ensuring providers perform a certain action rather than improve clinical outcomes. This is problematic for two primary reasons.

“First, process measures unlinked to better outcomes can drive provider efforts towards narrow interventions rather than holistic care,” Thompson says. “Second, these process measures add a significant number of tasks; even if they are not duplicative, process measures often entail substantial effort to collect.”

Furthermore, many of these measures have not been properly tested to ensure their ability to improve outcomes for patients. Some Measures Under Consideration are currently in abstract, Thompson notes, and until there is concrete evidence of their effectiveness, they should not be considered.

“Putting forth a concept of a measure rather than a fully developed, specified and tested measure for MAP review is inconsistent with the congressional intent that created the MAP,” Thompson argues.

“We appreciate CMS’s interest in obtaining the input of the MAP on measure concepts or ideas; however, we believe that task should not occur simultaneously with the review of measures being proposed for inclusion in a program.”

Ultimately, these recommendations are aimed at improving patient care and quality outcomes, AHA says.

“The AHA continues to believe the MAP’s best opportunity to promote broad improvement in health care is to use a streamlined set of actionable quality improvement priorities to identify ‘measures that matter’ the most to optimizing outcomes for patients and communities,” Thompson concludes.

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