Do CMS Measures Measure Up?

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Recently, Avalere presented on the issue of quality measures and clinical practice guidelines at Academy Health. We sat down with one of the researchers, Avalere's Minnie Song, to discuss this research.
Please note: This is an archived post. Some of the information and data discussed in this article may be out of date. It is preserved here for historical reference but should not be used as the basis for business decisions. Please see our main Insights section for more recent posts.

Q1: What was your objective for this paper?

A1: Quality measures are tools that are used to measure, healthcare processes, outcomes and organizational structures or system that are associated with the ability to deliver high-quality healthcare and are increasingly used for determining payment for providers. It is, therefore, important to make sure that quality measures are scientifically valid and meaningful. Clinical practice guidelines (CPGs) are generally used to support rationale of quality measures. In this sense, we wanted to see if CPGs that support quality measures that are used in pay-for-performance programs would meet the Institute of Medicine’s (IOM) standards for trustworthy guidelines. In 2011, the IOM identified 8 standards and 20 sub-criteria for developing trustworthy CPGs and published them in a report, “Clinical Practice Guidelines We Can Trust.”

According to the Avalere Quality Measures Navigator™, more than 600 measures are used to support 24 quality reporting and pay-for-performance programs implemented by CMS.

Q2: What are CPGs and why are they important?

A2: CPGs are a type of clinical guidance documents and usually published by professional societies. As I mentioned above, CPGs are the typical source used to determine the scientific rationale when developing quality measures. The clinical validity of quality measures hinges upon the evidence reviewed and incorporated in CPGs.

Q3: What were the findings of your research?

A3: We found that of the 19 CPGs evaluated, none of them fully satisfied all of the IOM standards. Fourteen of the CPGs (73.7%) met at least half of the 20 sub-criteria. None of the CPGs met patient/public representation in guideline development and systematic review criteria. More than 80 percent of the CPGs met the standards related to establishing transparency, establishing evidence foundations for and rating strength of recommendations, and articulation of recommendations.

Q4. What are the implications of the findings of your research on healthcare policy stakeholders?

A4: Given the select guidelines’ suboptimal adherence to the IOM standards, there is a need to systematically assess CPGs’ “trustworthiness” be yond our sample. Guideline developers should also strive to vigorously enforce the standards and disclose the development process transparently for the future development or update of CPGs.

You can view the full poster presentation below.

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