CMS and Private Health Insurance Groups Seek to Align Quality Reporting

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    Whitfield L. Knapple, MD, FACG Chair, ACG National Affairs

    Whitfield L. Knapple, MD, FACG
    Chair, ACG National Affairs

    On Tuesday, February 16th, the Centers for Medicare and Medicaid Services (CMS) announced a new set of proposed quality measure groups meant to make reporting requirements “more consistent and efficient” in both the public and private health insurance markets. The Core Quality Measure Collaborative is led by CMS and America’s Health Insurance Plans, an industry trade group for private health insurers.   According to reports, “by easing the reporting complexity for clinicians, insurers are also hoping to bring down costs for themselves and consumers.”

    The core measures announced on Tuesday will affect 7 areas, including: primary care, cardiology, gastroenterology, HIV and hepatitis C, medical oncology, obstetrics and gynecology, and orthopedics. Click to read the announcement and information on the gastroenterology measure set.

    What does mean for you?

    Right now, there are no requirements or changes to the current quality reporting programs.   In the near future, CMS hopes the new measurements will be adopted by both CMS and private insurers. Please note that measures in the GI set are already part of the Physician Quality Reporting System (PQRS).      However, moving forward, changes may be on the horizon in the private insurance market. Contact your ACG Governor if you hear that this may be happening in your state.

    What is ACG doing?

    ACG welcomes and shares the goals of “more consistent and efficient” quality reporting. However, the College is concerned about the reported goals of cost reduction, as this can translate into another reason for simply cutting GI reimbursement. ACG continues to work with CMS and private payors to improve quality of care. For example, ACG believes that the use of registries in the private market or “quality clinical data registries” already approved by CMS can not only improve care, but also lower programmatic costs. The difference being that participating in registries can also help ACG members in meeting various components in the forthcoming Medicare fee-for-service reimbursement system beginning in 2019. In passing the Medicare Access and CHIP Reauthorization Act of 2015, and authorizing this new payment system, Congress emphasized the use of registries to help meet these various requirements for reimbursement. Should CMS and private insurers require more quality reporting (as opposed to volunteering for more quality reporting), then participation in registries would make quality reporting more consistent and efficient, especially if thousands of gastroenterologists from all types of practice settings across the country are already participating in registries (such as GIQuIC).

    ACG also remains concerned that while private insurers may adopt these measures next year, this new Medicare reimbursement system does not begin until 2019. This may mean another layer of duplicative quality reporting for ACG members in the private market, in addition to PQRS, clinical quality reporting in “Meaningful Use,” or other Medicare facility-level quality reporting programs. Clearly, this does not further the goal of reducing complexity or increasing efficiency for clinicians.

    ACG remains committed to reducing reporting burdens and administrative costs borne by ACG members and your practices. Thus, we will continue to advocate on your behalf at CMS and with this collaborative.

    Whitfield L. Knapple, MD, FACG
    Chair, ACG National Affairs

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