GAO on Health Quality Measures

By November 11, 2016Commentary

The Government Accounting Office, of all entities, has weighed in health quality measures.  (GAO Report)   The GAO was actually asked by Congress to look at whether there were issues relating to the disparate measures developed and implemented by HHS and private payers and what burden this might impose on providers.  GAO’s review found that there are not a lot of quality measures were used in common by CMS, other public payers and commercial health plans.  This lack of commonality increases the administrative burden on providers, de-focuses and diffuses their quality improvement efforts and gives confusing information to consumers.  Three primary factors were identified for this lack of overlap.  One is that payers and other stakeholders make independent, uncoordinated decisions about which measures to use.  Another is variation in data collection and reporting systems.  And the final one is the widespread perception that many of the developed, and adopted, measures aren’t really particularly meaningful to patients, providers or payers.  The report acknowledges that CMS has made efforts to begin working with private payers to adopt a common set of core quality measures and has worked toward identifying ways electronic data collection and reporting could lessen the administrative burden on providers.  But the GAO also said that CMS and HHS haven’t prioritized this work and don’t have a comprehensive plan or timeline to complete it.  This is a critical point, particularly as more and more payers use quality results to impact provider reimbursements.  Some providers have just given up and accepted penalties rather than deal with the plethora of measures.  This is obviously not a good outcome.  A joint working group across providers and payers should come up with a very limited set of real outcomes measures, and perhaps process measures that have an indisputable link to outcomes, and those are the only measures that providers should be required to use.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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