News & Information

On February 16, 2016, CMS, in conjunction with major commercial health plans and physician groups, released the first set of core measures, which will be used as the basis for quality-based payments. Part of the MACRA - SGR repeal was to begin to implement payment systems based on quality measures rather than the previous PPS system. This announcement marks the beginning of this process.

CMS worked with Americas Health Insurance Plans (AHIP) and "a broad collaborative of health care system participants" to create quality measures which they feel will "support multi-payer alignment, for the first time, on core measures for physician quality programs. The core measure sets are intended to promote alignment of quality measures for the practitioner community (e.g., physicians) or group practice level accountability."

According to the announcement, the seven core measure sets are:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs), and Primary Care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics

Providers in these areas should take the time to review these measures regardless of their Medicare provider status. These measures were designed in conjunction with other payers so they are likely to be implemented as part of physician quality and performance reviews by many payers.

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Author: 
Wyn Staheli