Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Are Healthcare Quality Measures ‘Over-Built?’

By Ryan Mcaskill

In an open letter to CMS, MedPAC warns that the sheer number of quality measures could be creating problems.

- Healthcare quality measures have become a major priority in recent years for many hospitals. With the growing need for healthcare organizations to be accountable and the weight being put on value-based care, quality measures are important. However, there is a train of thought that the sheer number of incentives, penalties and funding that is reliant on various quality metrics has created a growing burden on providers to keep up.

In December, the Centers for Medicare and Medicaid Services (CMS) released its annual list of quality measures that are under consideration. This year’s report was 329 pages and included hundreds of measures that could be instituted to determine the quality of care provided by Medicare-certified facilities. CMS now has the option to include any of these measures for upcoming rule-making for over 20 Medicare quality reporting and value-based purchasing programs.

These measures are required to be published by December 1, the previous year to give stakeholders an opportunity to view, examine and comment on them before they are formally proposed to become official parts of the program.

This number is clearly high and some are starting to question if the measures are getting out of hand.

  • KLAS: Quadax, SSI Group Earn Top Scores for Claims Management
  • 3 Strategies to Innovatively Advance Emergency Care Delivery
  • Reimbursement Shortfalls, Uncompensated Care Costs Grew in 2016
  • DSH system Could See Reduction in CMS Funding
  • Potential Medicare Reimbursement Demo to Lower Part B Drug Prices
  • Examining Medicare’s Chronic Care Management Payments
  • How Beverly Hospital Succeeds at Revenue Cycle Management
  • CMS Releases MSSP Track 1+ Model Risk Structures, Eligibility
  • Public Market Financing Growth, Healthcare M&A Data Released
  • HHS Report Shows Progress Reducing Hospital-Acquired Conditions
  • Congress Passes 2-Year Cadillac Tax Delay, Repeal Possible
  • Bringing Profee, Facility Together to Maximize Coding Productivity
  • CMS Awards $110M in ACA Funds to Cut Avoidable Readmissions
  • ACA Support Rising to 55% as Physicians Value Quality Care
  • Greater Non-Physician Staffing Helps Healthcare Revenue Cycle
  • ICD-10 Week is Here: Implementation Preparation Checklists
  • CMS: Medicare Accountable Care Organizations Saved Over $466M
  • Top 4 Patient Financial Responsibility Collection Methods
  • Physician Compensation Models Need Value-Based Reimbursement
  • Cancer Costs Don’t Rise Faster than Other Healthcare Spending
  • House Bill Plans 2-Year ICD-10 ‘Grace Period’ Without Denials
  • GA Provider Receives Jail Time for a Healthcare Fraud Scheme
  • Using Big Data in the Hunt for Healthcare Fraud, Waste, and Abuse
  • Why Focusing on Hospital Readmission Causes Is Essential
  • Tennessee Shoots Down Medicaid Expansion
  • How Broader Primary Care Teams Can Decrease Healthcare Costs
  • Hospitals Oppose Further Medicare and Medicaid Cuts
  • CMS Postpones Deadlines for New Bundled Payments Model
  • Orgs Push for MSSP Track 1 Extension for Non-Risk-Bearing ACOs
  • CMS Launches Provider Engagement, Value-Based Care Initiative
  • Judge Denies Hospital Org Attempt to Block 340B Drug Payment Cut
  • HHS Unveils Simpler Medical Billing Process Challenge Winners
  • Medicare Advantage Average Payment Cut Hurts Beneficiaries
  • Primary Care Physician Shortage Driving Bump in Compensation
  • House Reps Ask for FFS Waivers for Alternative Payment Models
  • How Radiologists Can Join an Advanced Alternative Payment Model
  • Is Data Collection too Burdensome in CMS Final Payment Rule?
  • 4 State Medicaid Agencies Secure ICD-10 Deadline Extension
  • Hospitals Seek Non-Acute, Supplier Partners for Value-Based Care
  • Congress Asks CMS to Scrap Prior Authorization for Home Health
  • Black Book: CFOs Focused on ROI, Revenue Cycle Outsourcing
  • Bundled Payment Models Here to Stay Despite CMS Program Delays
  • ICD-10 News the Landslide Leader in 2015’s Top 10 Stories
  • Top Providers of Medicare Advantage, Drug Coverage Listed
  • Hospitals Want Practice Management Systems to Work with EHR, RCM
  • 5 Supply Chain Management Questions and Answers
  • Finding a Revenue Cycle Management System for Post-Acute Care
  • Addressing Regulatory Burden, Patient Payments Top HIMSS18 Trends
  • AHA, Hospital Groups Renew Call to End 340B Drug Payment Cuts
  • HHS, CMS Speak Out on CMS’s Innovation Center Pilot Project
  • Providers Save Healthcare Costs via Medication Adherence
  • Unreliable Health Plan Provider Directories Burden Providers
  • Prices Still Responsible for High US Healthcare Spending
  • States Look to Streamline Payer Enrollment, Cut Provider Paperwork
  • Staffing Shortages, Healthcare Reform Top C-Suite Concerns
  • AHA, AAMC to Challenge Site-Neutral Payment Policy in Court
  • ICD-10 Compliance: From Provider Uncertainty to Certainty
  • AHA Calls for Bundled Payments Delay, Reform for BPCI Advanced
  • Hospital Merger and Acquisition Activity Still Strong in Q1 2018
  • 31% of Providers Still Use Manual Claims Denial Management
  • OIG: Texas Agency Not Always in Accordance for Medicaid Payments
  • 3 Snags of Expensive Affordable Care Act Deductibles, Copays
  • Texas HHSC Failing at Medicaid Fraud Prevention
  • Providers Investing in Home Health to Prepare for Aging Population
  • Judge Voids CMS Rule Altering Medicaid DSH Payment Calculations
  • GAO: CMS MA Efforts Fail to Uphold Provider Network Adequacy
  • GAO: Healthcare Spending Data from CMS Inaccessible, Unreliable
  • Countdown to ICD-10 Implementation: August’s Top 4 Roundup
  • CMS Says 121 New Medicare ACO Participants Advance Quality
  • HCCI Partners with NORC to Create Data Enclave
  • CMS Releases Post-ICD-10 Claims Denial Reimbursement Metrics
  • NCQA Calls for Public Comment on Health Plan Accreditation
  • CHI, Dignity Health Push Back Hospital Merger Closing Date
  • CMS Awards Equipment Contracts to Reduce Medicare Spending
  • How the Bipartisan Budget Act of 2018 Impacts Claims Reimbursement
  • AHA Opposes HPID on HIPAA Transactions
  • Revenue Cycle Management Issues Top AMA’s 2014 List
  • 2012 MSSP ACOs Decreased Post-Acute Care Spending by 9%
  • CMS Releases Quality Payment Program Data Submission System
  • AMA Calls for Massive Overhaul of RAC Program
  • 92% of Docs Say Prior Authorizations Negatively Impact Outcomes
  • OIG Finds Medicare Payment Problems with Two-Midnight Policy
  • Fictitious Marketplace Enrollees Get Standardized Coverage
  • As Medicare Turns 50, Does It Still Make Financial Sense?
  • Financial analytics present RCM opportunities for hospitals
  • Kansas Medicaid experiences $72 million setback
  • 340B Hospitals Delivered $26B in Unreimbursed, Uncompensated Care
  • CMS Releases New Medicaid Enrollment, Medicare Coverage Data
  • AAMC Projects Physician Shortage to Reach 120K Doctors by 2030
  • Next Generation ACOs Save Medicare $62M, Maintain Care Quality
  • Payment Reform Strengthens Patient-Centered Medical Home
  • AHA Urges CMS to Withdraw Uncompensated Care Payment Changes
  • Medicare Advantage Value-Based Care Arrangements Up Revenue
  • Medicare Spends $3.1B More on Hospital-Employed Physicians
  • Ascension, Australian Co Form Global Healthcare Supply Chain Org
  • Providers Prefer Manual Nurse Scheduling Over Predictive Analytics
  • CMS Clarifies Site-Neutral Medicare Reimbursement Exceptions
  • Value-Based Care, Hospital Revenue Cycle Lead Top 2016 Stories
  • Patient Costs, Payer Responsibility Not Linked to Hospital Prices
  • CMS Provider Data Combats Medicare, Medicaid, CHIP Fraud
  • In an open letter to CMS and Department of Health and Human Services administrator Marilyn Tavenner, the Medicare Payment Advisory Commission (MedPAC) pointed out the problem that is being created and other issues that it may be covering up.

    “This year’s 329-page list of measures under consideration is a telling symptom of the larger problem,” Glenn Hackbarth, MedPAC Chairman, wrote. “Over the past few years the Commission has become increasingly concerned that Medicare’s current quality measurement approach is becoming ‘over-built,’ and is relying on too many clinical process measures that are, at best, weakly correlated with health outcomes.”

    It goes on to say that with a large number of process measures backed up by undesirable payment incentives because fee-for-service Medicare has increased the volume of services and is overly burdensome on providers to report. This also creates limited information to support clinical improvement or beneficiary choice.

    “Instead the Commission has urged more focused attention on a small number of population-level outcome measures, such as potentially avoidable hospital admissions, emergency department visits, and readmissions,” the letter reads.

    Hackbarth concludes that MedPAC acknowledges and appreciates the openness of CMS to accept comments during this process. He states that the sheer size of the most recent list reinforces concern that Medicare’s provider-level measurement activities are accelerating without regard to the costs or benefits of an ever-increasing number of measures.

    “We urge CMS to keep this broader perspective in mind as it moves into the proposed rule process for each Medicare program, and carefully consider whether each additional measure would simply reinforce or exacerbate the current system’s problems,” Hackbarth wrote.

    X

    Join 30,000 of your peers and get free access to all webcasts and exclusive content

    Sign up for our free newsletter:

    Our privacy policy


    no, thanks

    Continue to site...