The Centers for Medicare and Medicaid Services (CMS) is updating quality measure reporting across its Shared Services Program with the aim of improving quality of care.
The Shared Servings Program offers the opportunity for groups of medical providers and hospitals to form Accountable Care Organizations (ACOs), which voluntarily provide coordinated, high-quality care for Medicare beneficiaries. The payment system between CMS and ACOs incentivize providers to shift away from volume of care and toward value and outcomes. Participating groups must report quality data to CMS at the end of every year to maintain eligibility.
But the groups have faced various challenges aggregating data across their networks. As a result, CMS has been transitioning from web-based reporting to more digital methods like electronic clinical quality measures (eCQMs), merit-based incentive payment system quality measures (MIPS CQMs) and digital quality measures (dQMs).
These quality measures will help assess and track the quality of health care services ACOs provide, as generated by a provider's electronic health records, said CMS Performance Based Payment Policy Division of Program Alignment & Communication Director Steven Johnson during the 2022 HIMSS Conference in Orlando, Florida, Tuesday.
CMS solicited feedback from ACOs and learned they preferred the eCQM and MIPS CQM reporting and wanted to balance transition from legacy web reporting and data abstraction with new requirements around the quality measure standards and electronic extraction. The ACOs also expressed to CMS concerns around data aggregation across multiple EHRs and cost, so CMS established steps to adopt the eCQMs/MIPS CQM system.
CMS new six-prong strategy to implement quality measure changes include:
- Incentive for eCQMs/MIPS CQM reporting
- Extension of web interface collection for an additional three years to give more time to ACOs to transition to eCQMs/MIPS CQM reporting
- ACI listening session to provide plans and address concerns with reporting
- ACO engagement with Office of Burden Reduction and Health Informatics to address transition questions
- Written guidance documentation with stakeholder input for reporting
Johnson said that the new reporting transition will enable greater real-time monitoring, error reduction, direct electronic record extraction, and the adoption of certified EHR technology.
The team is currently developing written guidance to release "sooner than later," said Johnson.
Along with the eCQM/MIPS CQM reporting changes, CMS is also looking to transition ACOs to dQMs, which are quality measures, organized as self-contained measure specifications and code packages that use one or more sources of health information that can be transmitted electronically through interoperable systems. With this implementation, which involves data quality, technology, data aggregation and mature alignment, CMS hopes dQMs will also lead to better patient care, said CMS Division of Quality Measurement Electronic Health Record Technical Lead Joel Andress.
Through dQMs, CMS hopes to aggregate patient-level data to apply risk adjustment and attribution for accountability, integrate data from multiple sources — such as social determinants of health and patient-generated data — and repurpose siloed data for broad use. This, Andress said, would be a departure from the lack of interoperability, limited aggregation and governance and patient identification that currently exists across CMS’s aggregated data.
“[This] will give us the power of getting data from many existing sources into a common flow of standardized data to inform stakeholders in the process,” Andress said. “By aggregating the data, that can … fuel the learning engine that supports continuous improvement in both the deliver of patient care and knowledge.”