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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 other entities.

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

  • Cardiology

  • Gastroenterology

  • HIV and hepatitis C

  • Medical oncology

  • Obstetrics and gynecology

  • Orthopedics

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.