GAO: CMS must do better job monitoring quality programs, funding

Medicare spending costs money
The Government Accountability Office found the Centers for Medicare & Medicaid Services needs to improve how it monitors and develops quality measures. (Getty/zimmytws)

A government watchdog found the Centers for Medicare & Medicaid Services (CMS) hasn't done a good job of tracking quality program funding or whether quality measures meet goals.

The Government Accountability Office (GAO) said in a report issued last week that CMS lacks complete information on how much funding it allocates for quality programs. The federal watchdog also questioned whether CMS has the procedures in place to ensure quality measurements meet objectives for the program.

“Taken together, these issues limit CMS’s ability to determine whether its allocation of resources and quality measurement decisions are optimal or whether changes are needed in its approach,” the GAO report said.

The failings could have broad consequences as private payers often adopt CMS quality measures for commercial plans, GAO added.

RELATED: Rating the raters? Hospital experts turn tables and critique quality comparison sites

CMS adjusts Medicare payments to providers based on measures it creates to evaluate quality. Each measure must meet eight strategic objectives that include whether the measure is outcomes-based, patient-centered and aligns across other programs. But CMS doesn’t do a good job of determining whether the measures it adopts meet these objectives, GAO said.

For example, one of the objectives is that CMS create measures that impact 19 high-impact areas. These areas include healthcare-associated infections, mental health, admissions and readmissions to hospitals and medication management.

But last year, CMS’ quality programs had no measures that addressed the high-impact area called “equity of care,” and 13 out of 17 quality programs had no measures addressing “community engagement.” Both measures focus on working with communities on how to promote health best practices.

“Measure developers did not submit measures to CMS that addressed these areas, and CMS did not identify specific initiatives to address them,” the GAO said.

CMS did say that it supports collecting and analyzing data to enable future development of measures on those areas. But CMS also hasn’t developed performance indicators to determine if a measure makes progress on a strategic objective, GAO said.

CMS said it assesses the impact of a healthcare provider’s performance over a period of time. But these assessments only look at the provider, not whether CMS is doing a good job selecting and monitoring quality measures, GAO concluded.

RELATED: The magic number? AMGA wants to reduce quality measures from hundreds to 14

Another area of concern is how CMS is allocating funding for quality programs.

GAO’s analysis found that CMS has a large amount of funding for quality programs that hasn’t been used and is available. CMS gets funding for quality programs from congressional appropriations from bills such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

For instance, in federal fiscal year 2018 the MACRA quality programs had an unspent balance of $42 million.

GAO’s report, which was mandated by the 2018 Better Budget Act, said that CMS should maintain more complete information on its quality program funding. The agency also needs to develop more procedures for evaluating the progress of quality measures, GAO said.

The Department of Health and Human Services told GAO that it will look into fiscal accountability for the quality programs and will evaluate how to better review quality measures.