It is kind of funny to see one part of our massive federal government critiquing the actions of another part. You have to wonder what the Government Accounting Office knows about quality of care measures, but here they are giving us their perspective on Medicare’s quality program. Not that there isn’t a lot to be critical of. (GAO Report) CMS spends something like $30 million a year on quality measure development. It has a bewildering array of quality improvement efforts, such as health care associated infection reduction and hospital readmission reduction, as well as more general ones related to value-based purchasing. CMS relies on the National Quality Forum to actually develop and test most of the measures. The Medicare Payment Advisory Commission, among other groups, has noted that it would be better if CMS consolidated all these into one program and reduced the number of measures. GAO avoided directly commenting on these issues. But the primary GAO finding was that CMS has no systematic program to ensure that the measures it develops and uses are actually measuring or improving quality, which seems like it might be an important thing to do. In fact, there was a lack of documentation regarding how measures were selected and tested. That surprised me a little bit, because if you read the annual provider payment rules, there is always some discussion about quality measures, often with a great deal of detail on why certain measures are being used. GAO also noted that CMS was unable to directly explain how or if it spent the funds Congress specifically allocated for quality programs. No surprise there. GAO’s recommendations were largely process ones, which again likely reflects the fact that the Office doesn’t really have the capability to assess quality of care programs. Better for the government and the public to instead pay attention to MedPAC recommendations, as that group has extensive experience and staff expertise in the quality of care arena. These measures have real consequences–they can result in financial penalties to providers and they may lead providers to expend resources to do better on quality measures which really don’t make a clinical difference for patients. There is no question that all the quality reporting obligations placed on providers by Medicare and other payers jack up administrative costs and distract provider staff from the actual delivery of care to patients. So much greater care should be taken in developing and using quality measures.
