CMS Defines Physician Quality Reporting Improvement Efforts
By - The new future of the physician quality reporting system (PQRS) is now more clearly defined with the recent release of a fact sheet from the Centers of Medicare & Medicaid Services (CMS). Transparently reporting healthcare professionals’ performance levels, says CMS, enables physicians and healthcare consumers across the healthcare spectrum to make smarter decisions.
“CMS is working to streamline and simplify existing quality programs to reduce healthcare professionals’ participation burden, and recognizes that any vision for the future must acknowledge the constraints of existing physician quality reporting program requirements (e.g. rulemaking timelines), and regulatory processes that might be required to change them,” confirms CMS.
PQRS measures concentrate on various types of care, such as prevention, care coordination, and resource utilization. Says CMS, PQRS uses negative payment adjustments to encourage individual eligible professionals (EPs) providing services at critical access hospitals (CAHs) billing under method II and PQRS group practices participating in the group practice reporting option (GPRO) to report quality information reporting. A failure to satisfactorily report data on quality measures will lead to a negative payment adjustment via PQRS, CMS says.
“Driving quality improvement is a core function of CMS,” says the organization, additionally confirming it heavily relies on quality measurement and public reporting to deliver quality healthcare. “The vision for the CMS Quality Strategy, which is based on the National Strategy for Quality Improvement in Health Care (NQS), is to optimize health outcomes by leading clinical quality improvement and health system transformation. PQRS plays a crucial role to facilitate physician participation in this process committed to quality improvement,” CMS adds.
CMS confirms its five-part vision supports an evolving approach to healthcare provider payment:
- CMS quality reporting programs are guided by input from patients, caregivers, and healthcare professionals.
- Feedback and data drives rapid cycle quality improvement.
- Public reporting provides meaningful, transparent, and actionable information.
- Quality reporting programs rely on an aligned measure portfolio.
- Quality reporting and value-based purchasing program policies are aligned.
“Our Strategic Vision articulates how we will build upon successful physician quality reporting programs to reach a future-state where quality measurement and public reporting are optimized to help achieve the CMS Quality Strategy’s goals and objectives, and, therefore, contribute to improved healthcare quality across the nation, including better care, smarter spending, and healthier people,” CMS explains. The future optimization of measurement and public reporting, says CMS, will help contribute to the advancement of quality improvement across the healthcare industry.
To “operationalize” its strategic vision and help recognize and identity indicators of success, CMS confirms a series of actions it “may take” to achieve its Strategic vision. These examples include:
- Involve patients, patient advocates, caregivers, and healthcare professionals as working members of quality measurement and improvement activities
- Engage specialty societies and other stakeholders in the development of quality measures that apply to a wider range of specialists and provider types.
- Collaborate with local and regional quality improvement organizations to use CMS quality data to inform the design of quality improvement programs.
- Include patients, caregivers, and healthcare professionals as active participants in the design of future public reporting efforts.
- Encourage greater participation by healthcare professionals in CMS quality reporting programs, and increased access to and utilization of CMS-provided data.
- Pursue collaborative relationships with data aggregators to expand the reach of CMS quality data and the ability of users to access it.
- Develop and follow an enterprise-wide measurement strategy focused on patient-centered outcome and longitudinal measures.
“CMS invites diverse stakeholders, including patients, caregivers, and healthcare professionals, to share in their vision for how quality measurement and public reporting can support quality improvement efforts and contribute to improved healthcare quality across the nation,” CMS states, additionally confirming the alignment of this vision with a provider payment shift from a fee-for-service (FFS) payment system to value-based incentives based on quality and care.
“As CMS pursues its internal action plan for operationalizing the vision statements in the coming years, this document and its indicators of success will serve as a guidepost for new and ongoing efforts towards optimizing quality measurement and public reporting for quality improvement,” CMS concludes.
