Family physicians work every day to provide the best possible care to their patients. And increasingly, health care payers -- both public and private -- are asking physicians to measure the quality of that care.
Unfortunately, the measurement portion of the quality equation has been disjointed and cumbersome because of a lack of consistency among payers, who too often ask physicians to measure different pieces of patient care in a variety of ways.
That's why today's announcement(ahip.org) from the Core Quality Measures Collaborative -- a group to which the AAFP has devoted much time and effort in the past 18 months -- should be considered significant movement in the right direction.
In a joint release from all participating organizations, agreement was announced on core measures sets(www.cms.gov) for select areas of practice described as
- The Core Quality Measures Collaborative has released core measures sets aimed at harmonizing quality measurement for seven select areas of medical practice.
- The AAFP has played a leading role in the collaboration of multiple groups that has been ongoing for 18 months.
- The primary care measures sets are the most comprehensive and cover topics such as cardiovascular health, diabetes care and pulmonary health.
- primary care, accountable care organizations (ACOs) and patient-centered medical homes (PCMHs)(ahip.org);
- HIV/hepatitis C care(ahip.org);
- medical oncology(ahip.org);
- obstetrics and gynecology(ahip.org); and
"The collaborative has been working to create consistency and alignment across measures being used by both public and private payers," said the announcement. Furthermore, members of the collaborative look forward to promoting quality measures that are "evidence-based and generate valuable information for quality improvement, decision-making, and value-based payment and purchasing."
According to the statement, the core measures sets released today were designed to help patients, consumers and physicians "while maintaining parsimony, and reducing the collective burden and cost."
Academy CEO and EVP Douglas Henley, M.D., has been a player at the table since the collaborative's inception. He told AAFP News that the Academy's involvement was aimed at making physicians' lives easier by simplifying what they're being asked to provide to payers.
"The AAFP is well aware of the huge amount of administrative complexity and burden that impacts the daily work of our members and diverts time and resources away from direct patient care," said Henley. "A major part of this is the burden of multiple performance measures in quality improvement programs with no standardization or harmonization across payers.
Collaborative Releases FAQ Document
Today, the Core Quality Measures Collaborative announced agreement on core measures sets for seven select areas of practice. At the same time, the collaborative also provided answers to frequently asked questions about the group's work.
For instance, the FAQ document(ahip.org) explains in detail the collaborative's
- goals and approach to achieving a core measures set,
- criteria for selecting a core set of measures,
- implementation plans, and
- approach to retirement of measures.
The FAQ also addresses how the core quality measures sets just released relate to other key components of existing measurement programs such as patient attribution, sample size and performance benchmarks.
"This announcement demonstrates the AAFP's commitment to its members to reduce such administrative burden," he added.
Henley noted that the group's work was truly a team effort.
"By working closely with CMS, America's Health Insurance Plans, consumers, purchasers, and all the major health plans, this agreement on a set of core measures for primary care and the PCMH points to a pathway for the harmonization of evidence-based performance measures to be used by all payers," he said.
Henley also called for ongoing patience on the part of physicians.
"This will not happen overnight," he cautioned. "However, this agreement represents a big step toward the goal of administrative simplification and improved quality of care."
Framework for the Future
According to the announcement, the payers participating in the collaborative represent about 70 percent of the combined population of health plan enrollees and fee-for-service Medicare beneficiaries in the United States.
In addition to the AAFP, participating groups are the American Academy of Orthopaedic Surgeons, American College of Cardiology, American College of Physicians, American Gastroenterological Association, American Heart Association, AMA, American Society of Clinical Oncology, Council of Medical Specialty Societies, HIV Medicine Association, the Infectious Diseases Society of America and CAPG, a national organization that describes itself as "the voice of accountable physician groups."
Additionally, the American Academy of Pediatrics is working alongside physician groups on a core set of measures for pediatric medicine.
The announcement called 2016 a "transitional period" for the implementation and harmonization of measures and assured all stakeholders that the collaborative would provide ongoing monitoring and modification of all measures, as well as the selection of new measures as necessary.
In short, measures released today provide a "framework upon which future efforts can be based," said the announcement.
Measuring Primary Care
Of the seven core measures sets released today, it should be no surprise to family physicians that the set titled "ACO and PCMH/Primary Care Measures" is the most comprehensive.
The breadth of the core measures in this set illustrates the comprehensive scope of practice that is the hallmark of family medicine.
Core measures include activities associated with
- cardiovascular care, including control of high blood pressure, persistent beta blocker treatment after heart attack, and use of aspirin or another antithrombotic medication for treatment of ischemic vascular disease;
- diabetes care, including hemoglobin A1c testing and comprehensive eye and foot exams;
- care coordination and safety, including medication reconciliation; cervical, breast and colorectal cancer screening; and preventive care screening for tobacco use and body mass index;
- utilization and cost/overuse related to use of imaging studies for low back pain;
- patient experience, including timely appointments, physician communication with patients and access to specialists;
- behavioral health related to treatment of patients with newly diagnosed and existing depression; and
- pulmonary health, including medication management for patients with asthma and avoidance of antibiotic treatment in adults with acute bronchitis.
The collaborative also identified areas within this core set for which measures could be developed in the future. That list includes statin use guidelines, shared decision-making, preventive diabetes measures, palliative care measures, patient-reported outcomes, pain management measures, antibiotic stewardship, and substance use disorders and screening measures.
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