A New Quality Strategy for CMS

Four Pillars of the CMS Quality Strategy

Jean Moody-Williams, acting director for the CMS Center for Clinical Standards and Quality, welcomed more than 3,500 guests on day 1 of the 2020 CMS Quality Conference with a surprise for the crowd: a first look at the new CMS Quality Strategy with CMS Administrator Seema Verma.

Verma outlined the three tenets of the new Quality Strategy, which includes improvements to the quality and affordability of health care for all Americans; driving American health care towards payment for value, not volume; and lowering the rate of growth in America's health care spending. The CMS Quality Strategy rests on four pillars:

• Clear and reasonable expectations - or ​"rules of the road" - for quality by setting government standards in quality measures. In response to ​"chilling instances of unacceptably poor care," that continue to occur, CMS seeks to develop outcomes-based standards that minimize administrative burden and align across different care settings for consistency.

The Merit-based Incentive Payment System (MIPS), the framework for Medicare reimbursements, will evolve into value pathways that correspond with medical specialties or patient types. CMS proposes that these measures will be evaluated electronically, so ​"clinicians don't have to lift a finger" to transmit their quality measures via electronic health records (EHRs).

• Enforcement and oversight of those quality standards to ensure accountability. Verma outlined several initiatives designed to ensure consistent enforcement by the states and accrediting organizations charged with inspecting the 5,000 hospitals and 15,000 nursing homes that participate in Medicare each year.

• Transparency, competition and consumer choice through price and quality transparency. ​"To make fully informed decisions about their health care, patients must know the price and the quality of a good or service in advance," Verma said. To support this transparency, CMS is making more data available through an application programming interface (API) and redesigning its Compare tools that publicize quality of care information for patients.
   
• Prioritizing resources for those that need them most. Following an almost nine percent reduction in hospital readmissions, a 32 percent decrease in catheter-associated urinary tract infections, a 35 percent decrease in central line-associated bloodstream infections, and significant reductions in surgical site infections, Verma called for even more fundamental changes to quality improvement assistance delivered by QIN-QIOs. ​"The work of the QIOs is important, and cannot be understated," Verma said, ​"and we want to focus their expertise on providers that need it the most. Going forward, the work of the QIOs will be targeted to low-performing providers in rural areas who serve vulnerable populations."

Watch Administrator Seema Verma Present the Three Tenets of the New Quality Strategy

Achieving a Healthier Nation

"In our country, your zip code is still more important than your genetic code," declared Admiral Brett P. Giroir, assistant secretary for health for the Department of Health and Human Services, who noted that the U.S. ranks 28th in life expectancy among its peer countries. Giroir outlined his office's approach to preventive health care and its emphasis on reducing health disparities, including initiatives to end the HIV epidemic, reduce drug overdoses and improve care for people living sickle cell disease. Giroir ended his talk with these words of advice on the COVID-19 virus: ​"think about protecting your highest-risk individuals. No one's immune, but if you're a man 55 years and older and you have chronic health conditions, those are ones that are clearly in the high-risk group."

Fireside Chat on Strategic Priorities for the Agency

In a wide-ranging talk with CMS leadership led by Kim Brandt, CMS principal deputy administrator for operations and policy, CMS Principal Deputy Administrator and Director of the Center for Medicare Demetrios Kouzoukas noted that plans are in the works to offer individualized and supplemental benefits for individual health needs and to manage chronic conditions. Patients can now ​"spend more time looking at their doctor and talking to them, rather than staring at their lab coat as they enter data into the computer," thanks to a greater CMS commitment to removing documentation burden.

Patients at the Center: Why We Do What We Do!

Jean Moody-Williams concluded the morning's plenaries with a conversation about organ transplantation with the director of the NYU Langone Transplant Institute - and heart transplant recipient - Dr. Robert Montgomery and Precious McGowan, a kidney transplant recipient, patient advocate, and educator for people with end-stage renal disease. In this powerful session, Montgomery told the story of his decision to receive a high-risk organ from a hepatitis C- positive donor who died of a heroin overdose. Montgomery contracted hepatitis C but was treated and cured. ​"I'm a leader, and leaders should lead from the front and they should do what they are saying people should do themselves," Montgomery said. He became the 14th subject in his own trial studying transplantation of hepatitis C-positive organs.

McGowan waited eight years before she received a second kidney transplant last year. She and her husband chose to pay that gift forward by donating their son's organs after he died suddenly. ​"I remember the joy that I felt when I received a letter from the recipient of my son's kidney," McGowan said. ​"I felt gratitude. I felt that I was a part of saving someone's life."