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GAO Report Finds Changes Needed in Order for CMS to Assess the Effectiveness of its Quality Measurement Activities

September 24, 2019

McDermott+Consulting

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:

  • CMS lacks complete information on the total amount of quality measurement funding and the extent to which this funding supports its strategic objectives;
  • CMS funding information shows substantial unobligated balances in its quality measurement funding;
  • CMS takes different approaches in deciding which quality measures to use for different quality programs but it lacks procedures to ensure that these decisions are consistent with its quality measurement strategic objectives; and
  • CMS has not established performance indicators to assess its overall progress in achieving its quality measurement strategic objectives.

The GAO recommends that CMS should:

  • Maintain more complete and detailed information on its funding for quality measurement activities;
  • Establish procedures to systematically assess measures under consideration based on the CMS’s quality measurement strategic objectives; and
  • Develop and use performance indicators to evaluate progress in achieving its objectives.

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.

 


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459 or smadhani@mcdermottplus.com.

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