CMS Quality Strategy and Quality Measurement
AHA Annual Meeting
Dr. Patrick Conway, M.D., MSc CMS
Chief Medical Officer and Deputy
Administrator for Innovation and
Quality
Director, Center for Medicare and
Medicaid innovation
Director, Center for Clinical
Standards and Quality
May 5, 2014
The Six Goals of the CMS Quality
Strategy
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Make care safer by reducing harm caused in the delivery of care
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6
Strengthen person and family engagement as partners in their care
3
Promote effective communication and coordination of care
4
Promote effective prevention and treatment of chronic disease
Work with communities to promote healthy living
Make care affordable
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not
been publicly disclosed and may be privileged and confidential. It is for internal government use only and
must not be disseminated, distributed, or copied to persons not authorized to receive the information.
Unauthorized disclosure may result in prosecution to the full extent of the law.
CMS framework for measurement maps to the six national
priorities
Greatest commonality
of measure concepts
across domains
Care coordination
Clinical quality of care
•Transition of care
measures
•Admission and
readmission measures
•Other measures of care
coordination
•HHS primary care and CV
quality measures
•Prevention measures
•Setting-specific measures
•Specialty-specific measures
Person- and Caregivercentered experience and
engagment
•CAHPS or equivalent
measures for each settings
•Shared decision-making
Population/ community
health
•Measures that assess health
of the community
•Measures that reduce health
disparities
•Access to care and
equitability measures
Efficiency and cost reduction
Safety
•Healthcare
Acquired Infections
•Healthcare
acquired conditions
• Harm
•Spend per beneficiary
measures
•Episode cost measures
•Quality to cost measures
– Measures should
be patientcentered and
outcomeoriented
whenever
possible
– Measure
concepts in each
of the six
domains that are
common across
providers and
settings can form
a core set of
measures
CMS Quality Strategy:
Foundational Principles
Eliminate disparities
Strengthen infrastructure and
data systems
Enable local innovations
Foster learning organizations
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CMS Vision for Quality Measurement
• Align measures:
– With NQS and 6 measure priorities/domains.
– With external stakeholders (private payers, states)
– Across CMS programs whenever possible
• Create parsimonious or cores measure sets
• Implement measures filling critical gaps (patientreported outcomes, care coordination,
appropriate use, etc.) in rapid cycle
• Remove “topped-out” measures.
• Goal is improvement over time
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Future Hospital Quality Measurement
• Robust quality measures covering the 6 goals
from the CMS Quality Strategy
• Adopt Quality Measurement across care
settings
• Integrated quality reporting and pay-forperformance programs
• Submit once and fulfill multiple quality
programs
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Hospital Value Based Purchasing
• Additional stakeholder input
– Pre-rulemaking process to allow stakeholders to
submit measure concepts and given input
– Enables CMS to more quickly target measurement
goals identified in Quality Strategy
• Evolution of Quality Measures/Domains
– Expanding measures’ focus to outcomes, patient
experience and efficiency
– New quality domains for FY 2017 based on Quality
Strategy
– Monitoring and evaluation efforts ongoing
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Hospital Readmission Reduction
Program
• 5 condition specific measures
– AMI, HF, PN, COPD, THA/TKA
• Strive to be parsimonious
– All Cause Hospital Wide Readmissions (HWR)
measure
• Stakeholder support for this measure recognized by
CMS
• Likely lack statutory authority to implement measure
as currently designed.
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Hospital Acquired Conditions
Reduction Program
• FY 2017: 5 Hospital Associated Infections will
be implemented in addition to PSI-90
– CLABSI, CAUTI, SSI, MRSA, C. difficile
• FY 2015 IPPS/LTCH PPS proposed rule
– Seeking stakeholder input on electronically
specified measures of all-cause harm
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Future State for CMS Programs
• Improve quality of care using:
– Robust quality measures.
– Timely feedback to providers.
– EHR’s in a meaningful manner.
• Minimize reporting burden by:
– Synchronizing performance and reporting periods.
– Reduce number of required submissions by professionals
for eCQM data to one.
• Maximize efficiency by:
– Using eCQM reported data for multiple quality programs.
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The Future of Quality Measurement
for Improvement and Accountability
• Meaningful quality measures increasingly need to transition
away from setting-specific, narrow snapshots
• Reorient and align measures around patient-centered outcomes
that span across settings
• Measures based on patient-centered episodes of care
• Capture measurement at 3 main levels (i.e., individual clinician,
group/facility, population/community)
• Example gaps areas to be filled: patient reported outcomes, care
coordination, patient engagement, efficiency, etc
• Why do we measure?
– Improvement
Source: Conway PH, Mostashari F, Clancy C. The Future of Quality Measurement for Improvement and
Accountability. JAMA 2013 June 5; Vol 309, No. 21 2215 - 2216
Contact Information
Dr. Patrick Conway, M.D., M.Sc.
CMS Deputy Administrator for Innovation and Quality and
CMS Chief Medical Officer
410-786-6841
patrick.conway@cms.hhs.gov
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