Quality measures in healthcare still need refining, and in the meantime Congress needs to make outcomes align better with physician payment reforms, a former Medicare chief told lawmakers Wednesday.
Payment reforms need to include more efforts that focus on the episode or person level of care because that’s where true gains in improving quality can be made, Mark McClellan, MD, PhD, administrator of the Centers for Medicare and Medicaid Services (CMS) from 2004 to 2006, said.
Meanwhile, quality measurements can be refined to better track quality, McClellan told the Senate Finance Committee during a hearing on measuring quality in healthcare. Quality should also be based on patient outcomes — and not processes.
“The measures aren’t perfect, so initially you might not have payment tied to performance on the measure, or you might only have a small percentage of payment related to performance on the measure,” McClellan said. “But it’s a step in that direction that I think is much better than telling clinicians to improve care but then paying them in a way that doesn’t give them any resources to do it.”
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Measuring quality has become increasingly important in recent years as the Affordable Care Act has launched several programs to reward or penalize physicians based on performance.
More recently it’s become a topic in debate over repealing Medicare’s sustainable growth rate (SGR) physician reimbursement system as lawmakers discuss how to base doctor payments on value and quality.
House lawmakers have suggested quality measures under an SGR replacement be specialty-specific, but not every medical specialty has good quality measures.
McClellan cited Medicare’s existing quality programs, like the Physician Quality Reporting System (PQRS) and the upcoming Value-Based Payment Modifier (VBPM), as examples of quality reporting already underway, which could be mixed into new payment reforms.
But participation in PQRS has been lower than expected because of the reporting burdens on doctors. Instead, the various quality report initiatives need to be streamlined and better incorporated into clinical practice, he said.
“I think this goes to what Sen. [Orrin ]Hatch’s point earlier about trying to make quality reporting a consequence of delivering care, not a separate set of activities that need to be done on top of everything else that clinicians are already doing,” McClellan said.
There are other criticisms about quality measures besides their reporting burdens. Other lawmakers, including Sens. Bob Casey (D-Pa.) and Ron Wyden (D-Ore.), noted the lack of measures for pediatric care and chronic diseases.
Wednesday’s hearing wasn’t about the SGR, but instead was about lawmakers voicing concern for streamlining the various public and private quality programs that allow providers and patients to understand the value of the care they receive.
“Medicare uses 1,100 different measures in its quality reporting and payment programs,” Sen. Max Baucus (D-Mont.), chair of the Senate Finance Committee said in his opening statement. “And that’s just Medicare. Medicaid programs and dozens of commercial insurance companies all pay differently and run their own quality programs.”
If the healthcare industry is able to develop better ways to track quality, payers can use it to help steer patients to higher-value providers.
“If we make quickly available measures that differentiate high-performing providers from others, then employers will be able to change their payment policies, reconfigure their healthcare networks, and create consumer incentives to encourage people that they cover to get care from the high-performing organizations,” said David Lansky, PhD, president and chief executive of the Pacific Business Group on Health, a payer organization in San Francisco.
Date: Jun 26, 2013