CMS Issues Core Quality Guidelines
CMS guidelines are intended to support high quality care, reduce
physicians’ reporting burden.
On February 16, 2016, the Centers for Medicare and Medicaid Services
(CMS) released seven sets of “Core Quality Guidelines” to align quality measures
across the spectrum of programs and disciplines. Three years in the making, the
guidelines are a product of CMS, America’s Health Insurance Plans (AHIP), and
The guidelines are intended to support high quality care and, by
creating one uniform set of standards for both public and private payers, to
reduce the burden for clinicians who report on quality improvements.
The guidelines will also be used to promote the alignment of
quality controls for practitioners and to measure or group practice-level
accountability in the following areas:
Accountable care organizations, patient-centered medical
homes and primary care
HIV and hepatitis C
Obstetrics and gynecology
While the guidelines are in the early stages of the public
notice and comment process, CMS has already implemented them and expects that
private payers will soon begin phasing them in. The
CMS website provides more specifics as well as a downloadable copy of each
set of guidelines.
We strongly suspect that, in addition to their stated purpose,
the CMS guidelines will be used by both public and private payers in evaluating
care, making payment decisions, and determining whether care meets the required
levels of quality. It also seems likely that the guidelines will be used as a
standard of care in investigative matters.
We will continue to monitor these issues and share with you any developments
that we believe will interest you.