GAO calls for meaningful, better-aligned healthcare quality measures


The Department of Health and Human Services must set priorities in its bid to better align healthcare quality measures across payers and programs, and work to make those metrics truly meaningful, according to a report published Oct. 13 by the Government Accountability Office.

In the push toward value-based reimbursement, payers don’t agree on which quality measures to track. That creates a burden on providers, especially smaller organizations, to serve multiple masters. For instance, in assessing the care of diabetic patients, multiple payers may use a different threshold to determine which patients have their blood sugar levels under control, according to the report.

GAO cites three factors driving this misalignment:

  • Dispersed decision-making: Among public and private payers, each decides independently which quality measures to use and which specifications apply.
  • Variation in data collection and reporting systems: Physicians may collect the data using different electronic health record systems, paper records, or clinical data registries, with many details left to provider discretion. Without standard measures,  EHR vendors have little incentive to design systems to facilitate data collection and reporting.
  • Few meaningful measures: Though hundreds of quality measures have been developed, few are seen as leading to meaningful improvements in quality.

"What we have right now is a labyrinth of confusing metrics, specifications and reporting rules that serve no one," Kathleen Ciccone, R.N., said in introducing a Healthcare Association of New York State report calling for streamlined measures.

The GAO report recommends that HHS direct the Centers for Medicare & Medicaid Services to develop a comprehensive plan, including timelines, for more meaningful quality measures that promote better alignment.

It also called for CMS and the Office of the National Coordinator for Health Information Technology to prioritize development of electronic quality measures and, in particular, standardized data elements to report on those core measures.