Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Summary


In recent years, in an effort to assure quality health care, CMS has implemented performance measurement programs for six health care settings: hospital inpatient, hospital outpatient, physician services, skilled nursing facilities, home health care agencies, and dialysis facilities, that include a mixture of financial (for reporting) and non-financial (public reporting) incentives. Collectively, these programs include 249 measures that cover a broad array of measure types and clinical areas. The alignment of these programs, however, is relatively limited. Only ten clinical conditions are addressed by more than one reporting program, and seven of these are addressed by only two programs. The conditions addressed by more than one program have very little overlap of the actual measures or very similar measures included in more than a single program. Thus, the current set of performance measures offer little opportunity to use the performance reporting programs to create joint accountability for the care delivered to patients. This could change, however, as additional measures are included in the programs, particularly if efforts are undertaken to increase alignment of measures across programs and to expand out measures within clinical conditions to address relevant care delivered in various settings.

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