Since the healthcare industry has taken serious measures to revamp healthcare services, the emphasis on incentive payment programs has increased. MIPS and MACRA, and more offer facilities to physicians that regular payment methods can never provide.
Such incentive payment programs come with various quality measures against which clinical data is needed to report. The number of clinical quality measures is so large that it is difficult to manage them for each healthcare provider. Moreover, the requirements for each program be it Meaningful Use (MU), MIPS, or others, and the implementation of reporting criteria can be quite confusing.
The Center for Medicare and Medicaid Services (CMS) states Clinical Quality Measures (CQMs) for incentive payment programs. The result is not just to pay physicians but the value-based healthcare improvement efforts. These clinical quality measures also put their part in various government or private development projects.
Need of CQMs
Eligible physicians and hospitals submit data to CMS as in MIPS. In return, CMS estimates their performance and reward accordingly while checking that patients are getting the deserved attention from physicians. In addition, it works in favor of the healthcare industry to improve performance categories, falling short in terms of efficiency and quality.
What factors determine success in Clinical Quality Measures Submission?
As per the CMS website, it checks the following parameters to score CQMs.
- Use of available resources
- Compatibility to healthcare standards
- Healthcare outcomes
- Patient’s safety and welfare
- Coordination among physicians
- Patient’s engagement level
- Population & overall health standard
- Healthcare clinical processes
To maintain the accuracy and transparency in the healthcare system, ONC, Office of the National Coordinator for Health Information Technology (US Government Health and Human Services), monitors the use of EHR and other technologies.
The Development Process of Clinical Quality Measures (CQMs)
National Quality Forum
Many healthcare industry leaders and stakeholders take part in developing CQMs. However, measures standardized by the National Quality Forum (NQF) are considered as the top priority. Most of the incentive payment programs use their measures because their development process involves extensive research.
Another reason for adopting NQF quality measures is their work and objectives that match with that of CMS. Moreover, their initiative boosts the use of electronic healthcare records (EHRs).
Development Process via CMS
CMS also has its own measure development project known as The Measures Management system. This system is always in its evolution stage and sets values for business processes. The deduced measures also support MIPS and other incentive payment programs and provide an opportunity for their growth.
Real-Life Implementation of Quality Measures
Clinical quality measure reporting accounts for many uses, but its major reliance is on EHR technology usage or Meaningful Use. However, many healthcare providers deem Meaningful Use to be stressful and demanding. Moreover, not every quality measure is for everyone. Thus, there should be some flexibility in the reporting criteria.
CMS has gone to great lengths to overcome reporting issues and streamlined measures under seven categories. When physicians are reimbursed and incentivize, it becomes obligatory for them to maintain their performance instead of giving quality as a one-time shot.
Clinical quality measures are also a great aspect of the Physicians’ Quality Reporting System. Physicians are met with penalties when they don’t report according to the standards.
Thus, MIPS, MACRA, and other payment incentive programs can’t perform their actual functions without efficient marking of clinical quality measures. The key to success is the selection of accurate measures according to the practice and the value-based approach of practicing physicians towards patients.