Medicaid Receives First Quality Measures

The Department of Health and Human Services has released the first quality measures for the Medicaid program. The initial 26 measures were released in final form in a notice published January 4 in the Federal Register. Reporting will be voluntary and is not schedule to begin until December 2013. (See measures, below.)

“Identification of the initial core set of measures for Medicaid-eligible adults is an important first step in an overall strategy to encourage and enhance quality improvement,” HHS wrote in the notice. “States that choose to collect the initial core set will be better positioned to measure their performance and develop action plans to achieve the three part aims of better care, healthier people, and affordable care as identified in HHS’ National Strategy for Quality Improvement in Health Care.”

The Affordable Care Act required HHS create a quality measurement and reporting program for Medicaid by January 1, 2012. By this September HHS expects to release the technical specifications that states will use to collect and report the quality measures. Under the act the department has until January 2013 to develop a standardized reporting format that states will use to submit data to the Centers for Medicare and Medicaid Services.

Most of the measures included in the Medicaid Adult Quality Measures Program are already in use under other quality programs, including the CMS Shared Savings Program, the meaningful use EHR Incentive Program, and the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set (HEDIS). The selection of existing measures was a conscious effort to reduce the number of quality measures providers must collect and report in various private and government programs.

CMS and the Agency for Healthcare Research and Quality collaborated to identify the measures, beginning with a list of approximately 1,000 existing measures. A draft set of 51 measures was posted for public comment on December 30, 2010.

Many of the 100 comments received stated that reporting 51 measures would be too burdensome for providers and states. Other comments recommended that the Medicaid measures better align with other current quality measurement programs. In response, CMS reduced the number of measures to 26 and better matched them to other programs.

The Affordable Care Act also requires that CMS share the data it collects. Public reports must begin by September 30, 2014. Beginning that year CMS also must publish annually recommended changes to the initial core set that reflect the “results of the testing, validation, and consensus process for the development of adult health quality measures.”

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Key to the Table

NQF ID National Quality Forum identification numbers are used for measures that are NQF-endorsed; otherwise, NA is used.

Measure Steward:

  • AHRQ—Agency for Healthcare Research and Quality
  • CMS—Centers for Medicare & Medicaid Services
  • CMS-QMHAG—Centers for Medicare and Medicaid Services, Quality Measurement and Health Assessment Group
  • HCA, TJC—Hospital Corporation of America-Women’s and Children’s Clinical Services, The Joint Commission
  • NCQA—National Committee for Quality Assurance
  • Prov/CWISH/NPIC/QAS/TJC—Providence St. Vincent Medical Center/Council of Women’s and Infant’s Specialty Hospitals/National Perinatal Information Center/Quality Analytic Services/The Joint Commission
  • TJC—The Joint Commission

Programs in which Measures are Currently in Use:

  • CHIPRA Core—Children’s Health Insurance Program Reauthorization Act—Initial Core Set
  • CMS QIP—CMS Quality Incentive Program.
  • HIP QDRP—Hospital Inpatient Quality Data Reporting Program
  • Health Homes Core—CMS Health Homes Core Measures
  • MU1—Meaningful Use Stage 1 of the Medicare & Medicaid Electronic Health Record Incentive Programs
  • PQRS—Physician Quality Reporting Program Group Practice Reporting Option
  • Shared Savings Program—Medicare Shared Savings Program
  • VHA—Veterans Health Administration

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