Aligning Quality Measures for Public Reporting

On December 13, 2021

American Board of Medical Specialties (ABMS) Member Boards have an opportunity to work with the Centers for Medicare & Medicaid Services (CMS) on the development of specialty-specific quality measures that meet the new Standards for Continuing Certification (Standards) and align with public reporting requirements with the rollout of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs). This, according to speakers discussing Aligning Quality Reporting with Continuing Certification Programs at ABMS Conference 2021 held virtually this past September.

Based on stakeholder feedback, CMS has been working to simplify MIPS and reduce the reporting burden associated with participation, explained Michelle Schreiber, MD, Deputy Director of the Center for Clinical Standards and Quality, and Director of the Quality Measurement and Value-Based Incentives Group at CMS. MVPs are a subset of measures and activities, established through rulemaking, that are aligned and connected across MIPS’ performance categories for quality, cost, and improvement activities related to different specialties or conditions. The goal of MVPs is to move away from siloed reporting of measures and activities toward sets of measures and activities that are more meaningful to a clinician’s practice or specialty, or a public health priority, she said. Examples of MVPs, which will be a new option for MIPS reporting beginning in 2023, are Advancing Care for Heart Disease, Optimizing Chronic Disease Management, and Adopting Best Practices and Promoting Patient Safety within Emergency Medicine.

Currently, clinicians must select six quality measures from a total of more than 200 MIPS measures. Through MVPs, clinicians would choose four measures from a shorter predetermined list of 10 to 12 measures that are linked to relevant improvement activities. Of the quality measures, one of them must be either an outcome measure or a high priority measure if an outcome measure is unavailable. Regarding cost, to the extent feasible, participants will be scored on an episode-based cost measure calculated by CMS, or if that’s unavailable, a more wide-ranging cost measure such as Medicare spending per beneficiary. All MVPs will leverage MIPS’ Promoting Interoperability measures and a set of administrative claims-based quality measures that focus on population health/public health priorities. Moving forward, the intent is that CMS would be responsible for calculating the cost measures and some of the population health measures, reducing the reporting burden for clinicians. Dr. Schreiber anticipates that an equity measure will be included in all MVPs in the future.

She encouraged the Member Boards to collaborate with CMS in the development of MVPs, which promote lifelong learning and practice improvement, the same as the Member Boards’ continuing certification programs. “Clinicians are looking at their performance for quality and cost, as well as promoting interoperability and foundational population health measures, which drives value,” Dr. Schreiber said. Combining participation in a government mandated program with earning continuing certification credit or continuing medical education would be a win-win for participants. It also would be a win for Member Boards, along with specialty societies, that would be helping to determine the important things that should be measured for quality purposes, she said. The boards could even collaborate to help encourage the use of multi-specialty MVPs, which would promote teamwork. “CMS is happy and eager to work with certifying boards, specialty societies, and other stakeholders in the MVP development process,” Dr. Schreiber stated.

Specialty-wide Quality Strategy

Warren P. Newton, MD, MPH, President and Chief Executive Officer of the American Board of Family Medicine (ABFM), who also served as moderator, stressed the importance of establishing a specialty-wide Quality Strategy. He noted that the new Standards emphasize the importance of performance improvement (PI). They call for the Member Boards to develop an agenda for improving the quality in their discipline in collaboration with stakeholders, recognizing that the specialties are different and therefore have different priorities, Dr. Newton said. The Standards also require diplomates to participate in relevant activities that improve health and health care. Additionally, the boards should recognize a wide range of PI activities that diplomates can engage in to improve health and health care.

“It’s critical for specialties, along with all the stakeholders, to set their own quality agenda,” said Dr. Newton, who noted that ABFM has required chart auditing since the board was established 50 years ago. As maintenance of certification began, ABFM shifted chart auditing into a PI activity. Currently, each year about 30,000 diplomates complete a PI requirement; 95% of them describe the activity as relevant and 90% describe improvement in care, he said.

More recently, ABFM has been working with its specialty societies to determine a Quality Strategy. “It’s very clear among our partners that having quality measures that capture the heart of primary care is critical,” Dr. Newton said. ABFM’s Person-Centered Primary Care Measure (PCPCM) and Continuity of Care Measure are good examples of developing new measures that better capture the core work of the specialty.

Initiative to Create Meaningful Measures

Robert Phillips, MD, MSPH, Executive Director of ABFM’s Center for Professionalism and Value in Health Care, elaborated on ABFM’s efforts to develop specialty-specific quality measures, aligning its continuing certification program with MVPs.

ABFM’s Measures That Matter to Primary Care initiative is designed to ensure that the measures better represent the contributions of primary care physicians in improving care quality, he said. The Continuity of Care measure is already endorsed for use in ABFM’s PRIME Registry™, a qualified clinical data registry, and is moving through the CMS and National Quality Forum (NQF) endorsement processes. “It is the most potent quality measure for reducing costs and utilization and it also happens to be highly valued by patients and clinicians,” Dr. Phillips stated.

The PCPCM is a patient reported outcome performance measure developed by the Larry A. Green Center and Center for Professionalism and Value in Healthcare, with support from the ABFM Foundation. It was developed with input by clinicians, patients, and payers and a process that was supported by the Agency for Healthcare Research and Quality. The PCPCM is already being used in several different health systems around the world, he said. It has cleared the NQF endorsement process and is nearly through the CMS endorsement process. (Update: On Nov. 3, 2021, CMS approved the PCPCM as a MIPS measure for 2022.)

ABFM is working on many fronts to ensure that its measures really do matter to a clinician’s ability to improve care, Dr. Phillips said. ABFM promotes the creation of payment systems that support the measures. The board is working with CMS to determine policy for adjusting payments for social risk. ABFM is building out tools, such as its Population Health Assessment Engine, to address social determinants of health and help their diplomates meet those quality metrics. It also is collaborating with the Office of National Coordinator for Health Information Technology and the United States Census Bureau to develop measures that reduce burden and burnout for clinicians using electronic health records.

Dr. Phillips encouraged other Member Boards to adopt ABFM’s Measures that Matter to Primary Care initiative as a blueprint to develop specialty-specific quality measures. CMS is open to partnering with the boards to develop relevant PI activities that will shape and improve the specialties and honor the social contract that they have with the public, he said. “We believe that MVPs are critical to our autonomy and our capacity for self-regulation, and for demonstrating to the public that our intentions are to improve the quality of the care they receive,” Dr. Phillips concluded. “It really is about the specialties defining their value.”

Collaboration is Key

Jill Shuemaker, RN, CPHIMS, Director of Clinical Measures at ABFM’s Center for Professionalism and Value in Health Care, offered insights into the collaborative process for developing quality measures. “It’s so important to identify and build relationships with those who share your specialties’ principles,” she said. Know your key stakeholders, including researchers, physicians, specialty associations, federal partners, and patient advocacy groups. Learn who are the most passionate quality advocates; who has influence in the physician, payer, and policymaker communities; and who has expertise in the process and politics of the measure development enterprise. A natural byproduct of engaging with these stakeholders, early and often, is having solid buy-in from those who need to shepherd the adoption and dissemination of these measures, Ms. Shuemaker said.

It’s also important to develop a strategic plan and know how it’s connected to the Member Board’s strategic plan, she said. Outline existing CMS quality measures that could be pulled into an MVP. Then identify gaps that need to be filled. Look at the board’s infrastructure and determine what needs to be added that will enable the board to enter the quality measures development space. Know the board’s value proposition and create key messages for stakeholders that speak to the value for these groups and the cost of the opportunity lost. Most important, understand that others will fill those gaps for the diplomates if boards do not engage in the MVP development process. Ms. Shuemaker concluded her presentation by offering ABFM’s assistance to review its process for developing an MVP and to collaborate on developing others.

© 2021 American Board of Medical Specialties

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