CMS, in a collaboration with American’s Health Insurance Plans (AHIP), announced on February 16, 2016, seven sets of “core measures” to align quality measures required for physician reporting.  These core measures, available here, align the quality measures across public and private payers.

CMS states that more measures will be added in the future, and the current measures will be updated over time.  Health insurers and physicians have long been calling for CMS to align the quality standards because it is difficult for plans to implement different sets of standards, and doctors have been faced with too many redundant and conflicting quality measures.  Aligning the quality standards will allow the physicians to focus on improving care delivery.

CMS worked with AHIP, commercial payers, the National Quality Forum, national physician organizations, employers and consumers to come up with core quality measures.  The initial core measures are in the following seven sets:

• Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care
• Cardiology
• Gastroenterology
• HIV and Hepatitis C
• Medical Oncology
• Obstetrics and Gynecology
• Orthopedics

CMS designed the core measures to be meaningful to patients, consumers, and physicians.  According to CMS, “reducing burden on providers and focusing quality improvement on key areas across payers, quality of care can be improved for patients more effectively and efficiently.”  Private payers are expected to use a phased-in approach to implementing the core measures.  They will be incorporated as contracts with physicians come up for renewal. 

CMS says that the announcement “marks a major step forward for alignment of quality measures between public and private payers and provides a framework upon which future efforts can be based.”  

Reporter, Scott Cameron, Sacramento, CA, +1 916 321 4807, scameron@kslaw.com