Supplement Reviews

CMS, GAO Underscore Ebb and Flow of Quality Measures

That development and use of quality measures can be an excruciatingly gradual process marked by policy ebbs and flows was pointed up by two items that came across the transom of our research platform last week.

On the one hand, quality-measure proponents might see forward momentum in CMS’ request for comments on development of a new, more comprehensive measure of hospital readmissions. Before now, much of the agency’s attention had been directed to readmission measures targeted to discrete areas, such as COPD and vascular procedures. But a Yale New Haven draft methodology report for a new all-condition readmission measure sweeps in a much broader group of procedures (check out Table 1). Comments are due August 29, and CMS seeks feedback in areas like inclusion and exclusion criteria; organization of cohorts; and choice of covariates for risk adjustment.

In contrast, the second item serves as a reminder that actually implementing quality measures can be a hard slog. In a report on the Medicare physician feedback program, GAO noted difficulties in using quality measures in a way that is “meaningful, actionable, and reliable.” The report says additional steps — such as more physician input on the “usefulness and credibility” of individual measures — are needed before a workable value-based payment system can be put in place.

Alas, quality measures, like much else in life, may require taking at least one step back for every two steps forward.

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