September 24, 2019
On Thursday, September 19, 2019, the Government Accountability Office released a report on quality measurement activities of the Centers for Medicare and Medicaid Services (CMS) titled, “CMS Could More Effectively Ensure Its Quality Measurement Activities Promote Its Objectives.” This report, which was mandated by a provision in the Bipartisan Budget Act of 2018, found that CMS lacks complete information on the funds it was allocated for quality measurement activities, what portion of those resources had already been obligated and applies an inconsistent methodology to determine if resources used in this area are meeting established program objectives. GAO concluded that these issues must be addressed for CMS to determine the effectiveness of its quality measurement activities.
CMS uses a range of quality measures to assess the care furnished by Medicare providers. In recent years quality measurement has become increasingly important with CMS developing many distinct quality programs and Congress allocating resources to fund these initiatives. At times, providers have questioned the effectiveness of some of these measures. For this report, GAO reviewed CMS’s quality measurement activities by assessing the information CMS maintains on funding in this area and the process CMS uses to develop and use quality measures.
Key findings of the report are:
The GAO recommends that CMS should:
The Department of Health and Human Services concurred with all three recommendations.
More information on CMS quality programs is available here. CMS created the “Blueprint for the CMS Measures Management System,” commonly referred to as the Blueprint, to document the core set of business processes and decision-making criteria for measure development. More information on the Blueprint is available here. Finally, CMS developed the Measures Management System (MMS) as a standardized system for developing and maintaining the quality measures used in its various initiatives and programs. More information on the MMS is available here.