Improving health is our policy
Gives new responsibilities to the National Quality Forum (NQF) to make recommendations regarding the national quality strategy (see section 3011) and to endorse quality metrics. Requires periodic review of measures by CMS. Appropriates $20 million per year for FYs 2010-2014 for these purposes.
For background regarding implementation of this provision, see the CMS website with materials relating to its Measures Management System. See here for more information regarding the NQF.
In a related development, the Senate Finance Committee on June 26 held a hearing, “Health Care Quality: The Path Forward,” to discuss the state of quality and data measurements in Medicare, Medicaid and the commercial sector. Materials are available here.
On July 8, 2013, CMS released its CY14 hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule in which it contemplates these provisions of the ACA in its proposal. Comments on the underlying proposed rule are due by September 6, 2013. A CMS press release is available here.
On July 8, 2013, CMS released its CY14 Medicare Physician Fee Schedule (MPFS) proposed regulation, which delineates proposed payment changes to physician payments, in addition to effectuating ACA-authorized requirements consistent with these statutory provisions of the law. Comments on the underlying proposed regulation are due by September 6. A CMS press release is available here.
On July 31, HHS published put on display a copy of the statutorily required Notice indicating its receipt and review of the consensus-based entity’s – the National Quality Forum’s (NQF) – Annual Report to Congress and the Secretary on its duties, which were expanded by this section. The Notice pertains to NQF’s March 2013 report, which is available here.
On Nov. 22, 2013, CMS issued the CY 2014 ESRD final rule (slated to be published in the Federal Register on Dec. 2) in which – due to a phase in of the ATRA-mandated drug utilization adjustment – the “overall impact of the CY 2014 changes is projected to result in an average increase in payments of 0.0 percent from CY 2013 to CY 2014,” compared with an estimated net 9.4% cut foreseen in the proposed rule (which did not include a phase in). A press release is available here.
On November 18, 2013, CMS issued a draft quality strategy on which it solicited public comment through January 10, 2014.
In January 2014, the National Quality Forum (NQF) via the Measure Applications Partnership (MAP) released a pre-rulemaking report outlining 2014 recommendations on measures for potential use in over 20 federal programs. In February, NQF issued a Draft 2014 MAP Duals Interim Report. Nominations are being sought to serve on the MAP through 6pm EST on March 10, 2014.
On July 2, CMS issued its CY15 Medicare Physician Fee Schedule (MPFS) proposed rule delineating a number of payment policies impacting over one million physicians and other practitioners paid under the MPFS each year. The proposed rule also sets payment policies for the Clinical Laboratory Fee Schedule (CLFS) and other Part B payments for the upcoming year. These key ACA provisions are addressed in the underlying rule. See also: CMS’ accompanying facts sheets on the rule (here and here). Comments are due by September 2, 2014.
On July 15, HHS issued a notice announcing receipt of the ACA-mandated fifth annual report, conducted by NQF, the contracted consensus-based entity, highlighting performance measurement work conducted over the January 14, 2013 and December 31, 2013 period.
On Oct. 31, CMS posted the CY 15 Medicare Physician Fee Schedule (MPFS) final rule with comment (fact sheet) addressing a number of ACA provisions related to physician payment and quality. Citing the April 1 doc fix, the Protecting Access to Medicare Act (PAMA) of 2014, CMS notes that a 0.0% update applies between Jan. 1, 2015, and March 31, 2015, for a conversion factor (CF) of $35.8013 during that period (after budget neutrality adjustments). The SGR calculation applies thereafter (April 1, 2015-Dec. 31, 2015), with the final rule conveying a 21.2% payment reduction for this period relative to the CY14 CF, with a CF of $28.2239.
Pursuant to this section of the ACA, on Dec. 1, the NQF announced the convening of the MAP to consider health care quality and efficiency measures issued by CMS. This list of 202 standardized performance measures under consideration (beginning on pg. 17 of the PDF) includes measures that have or will be implemented by programs that fall under HHS’ jurisdiction. MAP reviews the measures through a two-month deliberative process that is open to the public. The measures considered by the group are made public at the beginning of the forum and will be available for review and comment beginning Dec. 23, 2014.
On Jan. 22, 2015, CMS unveiled (press announcement; blog post) the official launch of the addition of star ratings to the Dialysis Facility Compare DFC website, which the agency plans to update on an annual basis beginning this Oct.
On Feb. 17, CMS announced submission timeframes for 2014 PQRS data.
On Jan. 29, CMS announced a new information collection pertaining to the ASC Quality Reporting Program.
On Mar. 2, CMS released the 2015 National Impact Assessment of Quality Measures Report (2015 Impact Report). The report presents a comprehensive assessment of CMS’ quality improvement efforts, including specific quality measures toward that end.
On Mar. 20, CMS announced that it will conduct a survey that seeks “to understand whether the use of performance measures has led to changes in provider behavior, and where undesired effects are occurring as a result of implementing quality and efficiency measures.” Federal Register announcement here.
On Mar. 20, CMS announced that it will conduct a survey to “help identify characteristics associated with high performance, which if understood, could be used to leverage improvements in care among lower performing nursing homes.”
On July 8, CMS posted the CY 16 Medicare Physician Fee Schedule (MPFS) proposed rule, which delineates payment policies impacting over one million physicians and other practitioners paid under the MPFS each year (see fact sheet here). Citing the latest doc fix (P.L. 114-10), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS effectuates the statutory 0.5% increase. The proposed rule addressed this provision of the ACA. Comments are due Sept. 8.
On Sep. 3 HHS announced it received a report, prepared by a contractor, that makes “recommendations on an integrated national strategy and priorities for health care performance measurement in all applicable settings.
On Feb. 16, 2016, CMS announced along with America’s Health Insurance Plans (AHIP) (AHIP press release) the release of seven sets of core clinical quality measures for the first time intended for use in multi-payer settings.
On Oct. 14, CMS released its highly anticipated final rule finalizing requirements for implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the MACRA.
On Nov. 22, in a blog post, CMS highlighted completion of its annual list of 97 performance Measures under Consideration (MUC) for use in Medicare quality and value-based purchasing programs (see here or here), including via the Merit-based Incentive Payment System (MIPS), among other applicable programs (see pp. 6-7 of the agency’s report).
2017
On Feb. 2, 2017, NQF’s Measure Applications Partnership (MAP) submitted recommendations to HHS for the 2016-2017 pre-rulemaking cycle for 74 performance measures under consideration for use in 16 federal healthcare programs.
In early March, NQF announced that it is seeking nominations for organizations and individual subject matter experts to serve on the MAP. Nominations are due by Apr. 6.
On Mar. 17, NQF’s MAP issued a report, which aims to improve quality measurement in federal healthcare programs and reduce reporting burdens for providers.
SEC. 3014. QUALITY MEASUREMENT. (a) NEW DUTIES FOR CONSENSUS-BASED ENTITY.— (1) MULTI-STAKEHOLDER GROUP INPUT.—Section 1890(b) of the Social Security Act (42 U.S.C. 1395aaa(b)), as amended by section 3003, is amended by adding at the end the following new paragraphs: øamendment by section 10304 strikes ‘‘quality’’ and inserts ‘‘quality and efficiency’’ in new paragraph (7) but did not specifically amend heading of paragraph (7)(B) below (which has different typeface).¿ ‘‘(7) CONVENING MULTI-STAKEHOLDER GROUPS.— ‘‘(A) IN GENERAL.—The entity shall convene multistakeholder groups to provide input on— ‘‘(i) the selection of quality and efficiency measures described in subparagraph (B), from among— ‘‘(I) such measures that have been endorsed by the entity; and ‘‘(II) such measures that have not been considered for endorsement by such entity but are used or proposed to be used by the Secretary for the collection or reporting of quality and efficiency measures; and ‘‘(ii) national priorities (as identified under section 399HH of the Public Health Service Act) for improvement in population health and in the delivery of health care services for consideration under the national strategy established under section 399HH of the Public Health Service Act. ‘‘(B) QUALITY [AND EFFICIENCY] MEASURES.— ‘‘(i) IN GENERAL.—Subject to clause (ii), the quality and efficiency measures described in this subparagraph are quality and efficiency measures— ‘‘(I) for use pursuant to sections 1814(i)(5)(D), 1833(i)(7), 1833(t)(17), 1848(k)(2)(C), 1866(k)(3), 1881(h)(2)(A)(iii), 1886(b)(3)(B)(viii), 1886(j)(7)(D), 1886(m)(5)(D), 1886(o)(2), 1886(s)(4)(D), and 1895(b)(3)(B)(v); øAs revised by section 10322(b)¿ ‘‘(II) for use in reporting performance information to the public; and ‘‘(III) for use in health care programs other than for use under this Act. ‘‘(ii) EXCLUSION.—Data sets (such as the outcome and assessment information set for home health services and the minimum data set for skilled nursing facility services) that are used for purposes of classification systems used in establishing payment rates under this title shall not be quality and efficiency measures described in this subparagraph. ‘‘(C) REQUIREMENT FOR TRANSPARENCY IN PROCESS.— ‘‘(i) IN GENERAL.—In convening multi-stakeholder groups under subparagraph (A) with respect to the selection of quality and efficiency measures, the entity shall provide for an open and transparent process for the activities conducted pursuant to such convening. ‘‘(ii) SELECTION OF ORGANIZATIONS PARTICIPATING IN MULTI-STAKEHOLDER GROUPS.—The process described in clause (i) shall ensure that the selection of representatives comprising such groups provides for public nominations for, and the opportunity for public comment on, such selection. ‘‘(D) MULTI-STAKEHOLDER GROUP DEFINED.—In this paragraph, the term ‘multi-stakeholder group’ means, with respect to a quality and efficiency measure, a voluntary collaborative of organizations representing a broad group of stakeholders interested in or affected by the use of such quality and efficiency measure. ‘‘(8) TRANSMISSION OF MULTI-STAKEHOLDER INPUT.—Not later than February 1 of each year (beginning with 2012), the entity shall transmit to the Secretary the input of multi-stakeholder groups provided under paragraph (7).’’. (2) ANNUAL REPORT.—Section 1890(b)(5)(A) of the Social Security Act (42 U.S.C. 1395aaa(b)(5)(A)) is amended— (A) in clause (ii), by striking ‘‘and’’ at the end; (B) in clause (iii), by striking the period at the end and inserting a semicolon; and (C) by adding at the end the following new clauses: ‘‘(iv) gaps in endorsed quality measures, which shall include measures that are within priority areas identified by the Secretary under the national strategy established under section 399HH of the Public Health Service Act, and where quality measures are unavailable or inadequate to identify or address such gaps; ‘‘(v) areas in which evidence is insufficient to support endorsement of quality measures in priority areas identified by the Secretary under the national strategy established under section 399HH of the Public Health Service Act and where targeted research may address such gaps; and ‘‘(vi) the matters described in clauses (i) and (ii) of paragraph (7)(A).’’. (b) MULTI-STAKEHOLDER GROUP INPUT INTO SELECTION OF QUALITY MEASURES.—Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by inserting after section 1890 the following: øamendment by section 10304 strikes ‘‘quality’’ and inserts ‘‘quality and efficiency’’ in new section but did not specifically amend headings below (which have different typefaces).¿ ‘‘QUALITY [AND EFFICIENCY] MEASUREMENT ‘‘SEC. 1890A ø42 U.S.C. 1395aaa–1¿. (a) MULTI-STAKEHOLDER GROUP INPUT INTO SELECTION OF QUALITY [AND EFFICIENCY] MEASURES.—The Secretary shall establish a pre-rulemaking process under which the following steps occur with respect to the selection of quality and efficiency measures described in section 1890(b)(7)(B): ‘‘(1) INPUT.—Pursuant to section 1890(b)(7), the entity with a contract under section 1890 shall convene multi-stakeholder groups to provide input to the Secretary on the selection of quality and efficiency measures described in subparagraph (B) of such paragraph. ‘‘(2) PUBLIC AVAILABILITY OF MEASURES CONSIDERED FOR SELECTION.—Not later than December 1 of each year (beginning with 2011), the Secretary shall make available to the public a list of quality and efficiency measures described in section 1890(b)(7)(B) that the Secretary is considering under this title. ‘‘(3) TRANSMISSION OF MULTI-STAKEHOLDER INPUT.—Pursuant to section 1890(b)(8), not later than February 1 of each year (beginning with 2012), the entity shall transmit to the Secretary the input of multi-stakeholder groups described in paragraph (1). ‘‘(4) CONSIDERATION OF MULTI-STAKEHOLDER INPUT.—The Secretary shall take into consideration the input from multistakeholder groups described in paragraph (1) in selecting quality and efficiency measures described in section 1890(b)(7)(B) that have been endorsed by the entity with a contract under section 1890 and measures that have not been endorsed by such entity. ‘‘(5) RATIONALE FOR USE OF QUALITY [AND EFFICIENCY] MEASURES.—The Secretary shall publish in the Federal Register the rationale for the use of any quality and efficiency measure described in section 1890(b)(7)(B) that has not been endorsed by the entity with a contract under section 1890. ‘‘(6) ASSESSMENT OF IMPACT.—Not later than March 1, 2012, and at least once every three years thereafter, the Secretary shall— ‘‘(A) conduct an assessment of the quality and efficiency impact of the use of endorsed measures described in section 1890(b)(7)(B); and ‘‘(B) make such assessment available to the public. ‘‘(b) PROCESS FOR DISSEMINATION OF MEASURES USED BY THE SECRETARY.— ‘‘(1) IN GENERAL.—The Secretary shall establish a process for disseminating quality and efficiency measures used by the Secretary. Such process shall include the following: ‘‘(A) The incorporation of such measures, where applicable, in workforce programs, training curricula, and any other means of dissemination determined appropriate by the Secretary. ‘‘(B) The dissemination of such quality and efficiency measures through the national strategy developed under section 399HH of the Public Health Service Act. ‘‘(2) EXISTING METHODS.—To the extent practicable, the Secretary shall utilize and expand existing dissemination methods in disseminating quality and efficiency measures under the process established under paragraph (1). ‘‘(c) REVIEW OF QUALITY [AND EFFICIENCY] MEASURES USED BY THE SECRETARY.— ‘‘(1) IN GENERAL.—The Secretary shall— ‘‘(A) periodically (but in no case less often than once every 3 years) review quality and efficiency measures described in section 1890(b)(7)(B); and ‘‘(B) with respect to each such measure, determine whether to— ‘‘(i) maintain the use of such measure; or ‘‘(ii) phase out such measure. ‘‘(2) CONSIDERATIONS.—In conducting the review under paragraph (1), the Secretary shall take steps to— ‘‘(A) seek to avoid duplication of measures used; and ‘‘(B) take into consideration current innovative methodologies and strategies for quality and efficiency improvement practices in the delivery of health care services that represent best practices for such quality and efficiency improvement and measures endorsed by the entity with a contract under section 1890 since the previous review by the Secretary. ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this section shall preclude a State from using the quality and efficiency measures identified under sections 1139A and 1139B. øNote: A subsection (e) was also added by section 3013(b) and a subsection (f) was also added by section 10303(b) of HCERA¿ (c) FUNDING.—For purposes of carrying out the amendments made by this section, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in such proportion as the Secretary determines appropriate, of $20,000,000, to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2010 through 2014. Amounts transferred under the preceding sentence shall remain available until expended.
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