By Deborah Leyva

Link: CMS Lays Out Vision for Physician Quality Reporting Programs.

“With passage of H.R.2 [SGR repeal and Medicare provider payment modernization], key components of these physician programs will serve as the foundation for the Merit-based Incentive Payment System.” 

“The Strategic Vision describes in concrete terms how we will advance the goals and objectives for quality improvement outlined in the CMS Quality Strategy through these quality measurement and reporting programs.”

The Medicare Sustainable Growth Rate (SGR) is a method to control spending by Medicare on physician services. CMS’ Quality Strategy seeks to optimize health outcomes using clinical quality improvement and healthcare transformation, including payment reform. The vision streamlines existing quality programs to reduce healthcare professionals’ burden, acknowledging constraints of existing physician quality reporting program requirements and regulatory processes.


As announced in January, 2015 by HHS, the move to migrate from a purely fee-for-service (FFS) payment system to alternative payment methods, like Accountable Care reimbursement models, reward providers based on the quality and cost of care provided to Medicare beneficiaries. HHS announced the goal of “tying 30% of payments to quality and value through alternative payment models by 2016 and 50% by 2018 under alternative methods for payment reimbursement created by the Affordable Care Act. 

One aspect of the burden associated with quality reporting involves the collection of data from disparate sources in order to report and monitor quality performance. This is what I might consider the next step in technology use; movement from data captured in an EHR to analysis of clinical, operational and financial data collected from multiple sources. Data collection may accumulate in a data warehouse or an application used for data analysis. Monitoring performance and quality metrics provide the opportunity for continuous improvement in patient care and reduced costs.

As an example, Accountable Care Organizations (ACOs) have proven their ability to reduce Medicare costs in the short time of their existence. As of September, 2014, total net savings to Medicare was about $484 million in shared savings.


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