- The National Quality Forum’s (NQF’s) Measure Applications Partnership (MAP) recently provided recommendations to CMS on ways to align clinical quality measures and reduce administrative burden associated with federal reporting for providers in long-term and post-acute care (LTPAC) settings.
“NQF, and the MAP, are focused on getting to high-value, meaningful measures to improve care and outcomes for our nation’s 55 million Americans who rely on Medicare,” said NQF CEO and President Shantanu Agrawal, MD, MPhil in a recent press release. “These latest recommendations are about getting to actionable, meaningful information for patients and clinicians, while minimizing unnecessary burden for reporting and using quality improvement measures.”
In a 2018 report, MAP requested CMS align quality measures to better address critical quality issues, gaps in quality measurement, and the impact of quality measurement in LTPAC settings.
“Aligned measures allow for better comparability across settings and facilitate consumer choice,” emphasized MAP in the report summary.
While MAP acknowledged the progress CMS has made in attempting to improve quality measure alignment, the partnership maintained crucial measurement gaps in care coordination and transfer of information across settings still hinder the impact of quality measures.
MAP reviewed one measure under consideration (MUC) as part of the CMS Meaningful Measures initiative for one federal program addressing LTPAC settings. Additionally, MAP addressed potential measure gaps for the inpatient rehabilitation facility quality reporting program, the long-term care hospital quality reporting program, the skilled nursing facility quality reporting program, the home health quality reporting program, and the hospice quality reporting program.
MAP recommended CMS align measures with and across programs as part of criteria aimed at cutting down on the number of clinical quality measures through the CMS Meaningful Measures initiative. Measures removed from one program for demonstrating a low performance gap should potentially also be removed from other programs, the partnership suggested.
Furthermore, MAP advised measures encouraging providers to report the incidence of infections with very low incidence rates be evaluated based on their implementation costs in comparison to their benefit. The benefits of measuring the incidence of rarely-occurring infections may not be worth the cost.
MAP also recommended CMS maintain measures that apply specifically to unique care settings such as home health.
Ultimately, MAP stated it supports the Meaningful Measures initiative overall but asserts that CMS could further reduce administrative burden associated with quality reporting.
“MAP recognized the value in developing more composite measures, as they can address numerous facets of a quality problem and provide understandable information to patients,” wrote MAP.
“However, MAP noted that facilities and clinicians are still responsible for providing data on the underlying measures, and MAP recommended that CMS continue to ensure that measures in the program are driving improvements in quality,” the group continued.
In another MAP report released this year, the partnership convened a clinician workgroup to review MUC related to the Merit-Based Incentive Payment System (MIPS) and the Medicare Shared Saving Program (MSSP).
While MAP supports reduced administrative burden, the clinician workgroup emphasized the importance and value of prioritizing meaningful measures over low-burden measures.
The report noted “some of the most meaningful measures may have a high measurement burden,” and advised CMS that there “may be unintended consequences if low burden measures are prioritized over more meaningful measures that are more challenging to report.”
The partnership also emphasized the value of outcome measures and voiced its support for composite measures that offer a comprehensive view of provider performance. Additionally, MAP advocated for the implementation of a broad range of measures across providers, specialties, and patients.