An improv comedy spin on CMS core quality measures

Feb. 22, 2016 / By Kristine Daynes

CMS released seven sets of core quality measures earlier this month. They come from a collaboration with AHIP, NQF and other stakeholders to harmonize performance measures across commercial and government sectors. The purpose is to “support multi-payer alignment, for the first time, on core measures primarily for physician quality programs.”

Yes, and. . . ?

The “Yes, and. . .” principle of improvisational comedy suggests that we should accept what has been stated (“yes”) and expand on that line of thinking (“and”). In other words, yes, seven sets of standardized measures are good. And, here’s what I would add to it:

1. Expand from disease-specific measures to holistic measures representing all of a patient’s conditions, including functional health
2. Balance measurement of preventative care (such as completion rates for mammograms and well-child visits) with measurement of the avoidable effects of inadequate care (such as preventable hospitalization and ED visits)
3. Augment encounter-based and episode-specific measures with long-term health outcomes, aligning them patient goals as well as disease-management objectives
4. Consider not just how care is delivered and whether patients improve, but also timeliness of care and access to appropriate providers and facilities
5. Simplify complex measures into a consolidated score or index (still retaining clinical relevance)
6. Apply predictive models to assess patient risk and support interventions
7. Measure total cost of care (because cost-effectiveness is really at the heart of the quality push)

This isn’t a theoretical wish list. These measures exist, but haven’t met the consensus of the stakeholder group CMS worked with to produce the first standardized core measure sets.

So what’s the punchline? The trickiest patients to care for—those with multiple conditions or behavioral health issues, chronically sick children or disadvantaged populations—aren’t very well represented by disease-based measures. But that’s what CMS delivered.

Physicians shouldn’t treat to quality measures. They need to treat the whole patient. A “Yes, and. . .” response to the core quality measures accepts them and suggests that patient-centric measures are the best gauge of all—reflected by health status, long-term health goals and a clinician-patient relationship in context of family and community. That doesn’t make for a funny punchline. But it should be the bottom line.

Kristine Daynes is marketing manager for payer and regulatory markets at 3M Health Information Systems.