SummaryOn July 9, Health & Human Services (HHS) announced the formation of the Quality Summit (QS), as directed by a recent executive order aimed at improving price and quality transparency.
The purpose of the QS is to convene government and healthcare industry stakeholders to assess government programs, identify opportunities for greater efficiency, and ensure that HHS programs are meeting agency goals.
The QS will initiate discussions on the Health Quality Roadmap (mandated by the price and quality transparency executive order), that aims to align quality and reporting practices across disparate HHS programs. It will be chaired by Deputy Secretary Eric Hargan and Peter Pronovost, M.D., Ph.D., Chief Clinical Transformation Officer at University Hospitals.
Though details about the QS are limited, the HHS announcement indicated that QS participants will address the opportunities to modernize HHS quality programs by focusing on “patient-centered approaches that drive competition, quality, and access to care.” Additionally, QS participants will review regulatory burdens that may inhibit provider ability to deliver high-quality care.
The QS is just 1 of several recent HHS initiatives that builds on existing HHS efforts aimed at reviewing quality programs, streamlining measures, reducing provider burden, and improving health outcomes. Other notable efforts initiated under the current and previous administrations a including the Core Quality Measures Collaborative (CQMC) and the Meaningful Measures framework as part of Patients Over Paperwork. It will be critical for healthcare stakeholders impacted by quality measure alignment to understand how and whether these concurrent initiatives will overlap with each other.
Data Transparency and “Shopping for Quality”
The Centers for Medicare & Medicaid Services (CMS) designed its Compare websites to provide quality information on care settings (e.g., hospitals) and physicians. However, these sites are underutilized and feature data that is poorly understood by patients. The impact of Compare websites is yet to be determined as the agency aims to provide more meaningful and actionable data to support patients’ decision-making. Moreover, it remains unclear whether the implementation of better measures will actually drive performance transparency and lead patients to “shop[…] for quality” as indicated in the executive order. QS participants may advise HHS to revamp these websites to provide data that is digestible, usable, and relevant to patients.
Aligning Across Stakeholders and Alignment Initiatives
Several stakeholders are involved in developing and recommending quality measures for adoption, development, and review, including the National Quality Forum and the National Committee for Quality Assurance. However, with varying stakeholder participation, aims, and guiding principles, it remains to be seen whether these efforts simplify and improve measures as intended or simply add to the confusion and provider burden.
Balancing Contrasting Goals
An inherent tension exists between measure alignment and provider flexibility efforts. For example, in 2019, CMS removed several measures from MIPS, citing application of the Meaningful Measures framework. The removal of these measures may have led to significant reporting efficiencies. However, many of the measures removed were popular among clinicians, assessed important clinical processes, such as administration of vaccines, and have not been replaced with measures that align with new CMS priorities. This presents challenges for specialists, particularly those for whom broader population-based measures may not adequately apply to the care they provide. It will be important to ensure that clinicians are able to continue reporting measures that are relevant to their patients.
The goal of administrative burden reduction under the Patients Over Paperwork initiative also may undermine the goals of the Promoting Interoperability program for hospitals, previously known as Meaningful Use. Under the new program, providers must enable patient access to data and send electronic notifications to clinicians when a patient is admitted, discharged, or transferred from the hospital (among other requirements). Contrary to program goals, the revamped Promoting Interoperability program may inadvertently increase provider burden given the persistent lack of adoption of more advanced certified EHR technology capable of facilitating the new requirements for patient data access and transportability.
How to Participate in the QS
The QS will be comprised of government stakeholders and 15 non-government healthcare industry leaders. Because the Roadmap will present a strategy for aligning measures across HHS programs and eliminating low-value measures, it will be important for industry to have a seat at the table to ensure that their priorities are reflected in the Roadmap. HHS is currently accepting nominations for participants through Wednesday July 31, 2019. Interested parties should submit a CV or resume and 1-page cover letter summarizing an applicant’s qualifications electronically to DeputySecretary@hhs.gov with the subject line “Quality Summit Application.”
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