Each new value-based reimbursement (VBR) model comes with the same promise: better patient outcomes at less cost with providers being rewarded for achieving those desired results. Each VBR model also comes with a different and unique set of clinical quality performance measures for participating providers.
As the number and complexity of VBR models grow, so do the number and complexity of the quality performance reporting requirements on providers. For many providers, the compliance burden of the reporting requirements exceeds the value they bring to care delivery. For some, that means spending more time on compliance and less time on patient care. For others, that means taking a pass on VBR opportunities that can benefit them and their patients.
Easing the Quality Measures Reporting Burden
Attaching a dollar amount to that compliance burden was a recent study in the March issue of Health Affairs that estimated that
physician practices spend $15.4 billion each year to report quality measures to public- and private-sector payers. The study said, “While much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report.”
Almost as if it anticipated the study in Health Affairs, the Centers for Medicare & Medicaid Services in February made a game-changing announcement that affects the quality measures reporting requirements on providers generally and on physician practices specifically. The CMS said it and major private health insurers and major physician organizations agreed to
standardized core sets of quality measures for seven delivery models and clinical services lines. In short, the agreement means that physician groups will be collecting and reporting the same set of quality measures to all payers for a particular delivery model or clinical service line.
Four Ways the Consensus Drives System-Wide Value
I believe that the stakeholder consensus on the reportable quality measures for seven delivery models and clinical service lines drives value to the health care system in four ways.
The first – and most obvious way – is reducing the compliance burden on physicians. With a common set of measures, no matter which payer a practice is working with, physicians are collecting and reporting the same information rather than collecting and reporting different information for each payer. That frees physicians up to focus on what's really important, and that's the practice of medicine.
The second way is drawing a closer connection between clinical performance and reimbursement. A common set of measures focused on outcomes makes it easier for physicians to see how what they do affects the health of their patients and the financial performance of their practice. The data become meaningful measures of consistent expectations of their work rather than inconsequential numbers required by different payers.
Third, by reducing the compliance burden and demonstrating the correlation with better clinical and financial results, a common set of quality measures will encourage more physician practices to participate in VBR arrangements. When that happens, the entire health care system and all its stakeholders benefit, particularly patients, as the share of total payments based on performance grows.
Fourth, a common set of quality measures fosters collaboration between providers and payers, especially when it comes to contract negotiations. Rather than negotiating over what measures have to be reported and how much has to be reported, providers and payers can focus on how to use the information to improve care and eliminate unnecessary costs.
Using the Consensus Measures at the Practice Level
Perhaps of greatest interest to physician groups is the consensus set of core quality performance measures for ACOs, patient-centered medical homes and primary-care practices. Many groups have been reluctant to participant in ACOs or become certified PCMHs because of the performance data demands from payers.
The CMS, private insurers and physician groups agreed to 22 quality measures in eight areas of care: cardiovascular; diabetes; care coordination and patient safety; prevention and wellness; utilization and cost; patient experience; behavioral health; and pulmonary. They also identified 20 additional areas in which measures are under development, including pain management and antibiotic stewardship.
For physician practices that want to get into the VBR game or for those challenged with compliance issues under existing VBR contracts, the agreement offers a number of practical considerations and solutions. For example:
- Do the 22 quality measures apply to my practice?
- Do we understand and are we knowledgeable about the 22 measures?
- Are we capable of collecting and reporting on all 22 measures?
- If not, what resources do we need to collect and report on all 22 measures?
- If so, what resources do we need to collect and report on the measures under development?
Physician practices should assign the responsibility for answering those questions and executing the solutions to an existing or new senior executive like the head of quality management or the head of data, analytics and reporting. Practices also should talk to their EHR vendors to ensure that they have the technical platform and capabilities to collect, analyze and send the data to payers.
Practices that don't develop that management and technical expertise will put their reimbursement at significant risk if they are currently or become ACOs or PCMHs. But for those practices that do, the consensus quality measures offer a predictable and manageable compliance path to participating in VBR arrangements that promise better health outcomes for patients and better business outcomes for physicians.
Related: Learn about McKesson's Value-Based Care Services.
Four Ways Consensus Quality Measures Will Drive Health Care Value
- Reduces the compliance burden on physicians.
- Draws a closer connection between clinical performance and reimbursement.
- Encourages more physician practices to participate in VBR arrangements.
- Fosters collaboration between providers and payers.