Guest Commentary: CMS Continues to Raise Stakes on Quality Measurement


This is the third in a series of blog postings summarizing issues, methods and results from current research in the Center for Value in Healthcare. We will be presenting a JSPH Forum entitled “Translating Research into Policy and Practice” on January 11th, 2012 with more details of the Center’s work.

Valerie P. Pracilio, MPH, Project Manager for Quality Improvement
and Bettina Berman, RN, Project Director for Quality Improvement

Measuring quality of care in the inpatient setting has been a staple of the healthcare environment for several years. Hospitals are penalized financially if they do not report data to the Centers for Medicare and Medicaid Services (CMS) on certain conditions, so solid measurement criteria is a necessity.

CMS’s desire to increase accountability at the provider-level created a need to assess quality in outpatient settings. In 2006, a governmental mandate led to the establishment of the Physician Quality Reporting System (PQRS) to incent eligible professionals who satisfactorily report data on quality measures for services provided to Medicare beneficiaries. Since then, JSPH has been collaborating with Quality Insights of Pennsylvania (QIP) on the development and maintenance of the measures included in the PQRS program.

Measurement development is a rigorous process that must be supported by solid evidence and must also consider feasibility of application in practice. Through our engagement with the QIP, our team has supported this process through evidence gathering and grading. A Technical Expert Panel (TEP) established for each measure also works with QIP to discuss feasibility of measure application. JSPH plays a part in engaging relevant experts to serve on the panel and presents the evidence to support their decisions. Once the measure development process has concluded, the measures are submitted to the National Quality Forum (NQF) for endorsement and broadly disseminated.

At Thomas Jefferson University, the faculty practice plan, Jefferson University Physicians (JUP), has participated in the PQRS program since its inception. Under the leadership of Dr. David B. Nash, the committee that oversees JUP’s performance improvement activities, the JUP Clinical Care Subcommittee (CCS), decided that participation in this program would be valuable to advance quality of care. A strong collaboration between the JUP Performance Improvement Team and JUP administration led to successful implementation of the PQRS program in all practices. The team works closely with practice representatives to select measures for submission and provides ongoing education and support for the practices. As a result, JUP has successfully increased physician participation and incentive payments over the past four years since the start of the program.

More accountability is on the way. CMS plans to move from pay for reporting to pay for performance. Beginning in 2013, CMS will publish PQRS data on the Physician Compare website for providers who report on quality measures through the Group Practice Method (GPRO). In 2015, the stakes will be raised even higher when providers’ Medicare payments are adjusted downward if they do not participate in the PQRS program. The question remains – will demand for provider accountability benefit Medicare beneficiaries?

As always, we are interested in your comments.

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