CMS Can See Clearly Now, Releases PQRS Strategic Vision

All month long, we’ve talked about the healthcare industry’s rapid evolution from the fee-for-service Stone Age to the pay-for-performance Enlightenment Period. Yes, payment reform is upon us, but don’t take our word for it—take it straight from America's largest payer of healthcare services: The Centers for Medicare and Medicaid Services (CMS). In an effort to “contribute to improved healthcare quality across the nation,” CMS recently published the Physician Quality Reporting Programs Strategic Vision, detailing a long-term plan for the quality measurement of physicians, professionals, and public reporting programs.

Building Better Healthcare

According to CMS, the Strategic Vision will build upon “current successes in quality measurement and public reporting,” as measured against the goals and objectives outlined in the 2013 CMS Quality Strategy. CMS envisions a future in which “quality measurement and public reporting play a critical role in healthcare quality improvement”—a vision defined by these five distinct vision statements:

• Input from patients, caregivers, and healthcare professionals will guide the programs.
• Feedback and data drives rapid cycle quality improvement.
• Public reporting provides meaningful, transparent, and actionable information.
• Quality reporting programs rely on an aligned measure portfolio.
• Quality reporting and value-based purchasing program policies are aligned.

To determine the success or failure of its mission, CMS also established eight indicators of success, described within the Strategic Vision:

• Patients, caregivers, and healthcare professionals are key contributors and active participants in measure development, reporting, and quality improvement efforts.
• Technology enables healthcare professionals to monitor quality measure performance at the point of care on an ongoing basis.  
• Quality measurement results drive the planning of quality improvement initiatives.
• Meaningful, actionable performance data are accessible to and used by a variety of audiences (e.g., patients, caregivers, and healthcare professionals).  
• Patients and caregivers have timely access to performance information tailored to their needs.
• An aligned portfolio of health IT-enabled quality measures supports all CMS public reporting, quality improvement, and value-based purchasing programs.  
• A stable and robust infrastructure exists, thus allowing for development and implementation of health IT-enabled quality measures.
• Principles, policies, and processes for all CMS quality reporting and value-based purchasing programs are coordinated.

The decision to implement a new payment system is a hefty one, and it’s clear that CMS won’t make any sweeping changes without provider input. Within the Strategic Vision, CMS explicitly invites diverse stakeholders—including patients, caregivers, and healthcare professionals—to share how they feel “quality measurement and public reporting can support quality improvement efforts and contribute to improved healthcare quality across the nation.” Keep an eye out for public comment periods, open-door forums, opportunities to join technical expert panels (TEPs), and the chance “to submit quality and efficiency measures for consideration for adoption into the Medicare program.”

Ready or Not, Here it Outcomes

This Strategic Vision will optimize and align quality measures to “support better decision-making from doctors, consumers, and every part of the healthcare system.” Designed with “CMS’ evolving approach to provider payment” in mind, the Strategic Vision brings us one step closer to “payment models that reward providers based on the quality and cost of care provided.” CMS’ desire to achieve a healthcare system that drives better care, smarter spending, and a healthier population means providers need to prepare themselves for the payment models of the future.

In a world where payers increasingly value quality over quantity—and providers bear the burden of proof—outcomes will become a critical piece of the payment puzzle. Do you know how your practice is performing?