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  • CMS, Private Insurers Agree on Health Care Outcome Measures

    Everyone agrees that the future of health care will be driven by outcomes. But which outcomes will be doing the driving? A major-player collaborative that includes the Centers for Medicare and Medicaid Services (CMS) and the country's leading private insurers' organization has unveiled its first answers to that question.

    In mid-February, the Core Quality Measures Collaborative released its first-ever consensus document to "identify core sets of quality measures that payers have committed to using for reporting as soon as feasible," according to CMS, which joined with America's Health Insurance Plans (AHIP), purchasers, consumers, and physician and other care provider organizations to develop lists of standard outcome measures in 7 clinical areas. Besides CMS and AHIP, participants included the American Medical Association and the American Academy of Family Physicians.

    The inaugural 7 areas addressed by the measures are cardiology; gastroenterology; HIV and hepatitis C; medical oncology; obstetrics and gynecology; orthopedics; and accountable care organizations (ACOs), patient centered medical homes (PCMHs), and primary care. According to AHIP, these will be the first in a series of "broadly agreed upon core measure sets that are aligned and harmonized across public and private payers."

    Measures listed in the orthopedic category may be of particular relevance to physical therapists and physical therapist assistants, and include risk-standardized complication rates after total knee arthroplasty (TKA) or total hip arthroplasty (TKA), and hospital-level 30-day readmission rates after TKA or THA. Also worth noting: measures in the ACO/PCMH/primary care category that include body mass index (BMI) screening and follow-up rates, and use of imaging studies for low back pain.

    In addition to the core measure sets, the aollaborative also identified future areas for measure development. These include "goals of patient care and education," "shared decision-making," "pain management measures," and "preventive diabetes measures" in the ACO/PCMH/primary care grouping. In the orthopedics category, "patient reported outcomes," "functional status measures for patients undergoing orthopedic surgery," and "transitions of care" are among the areas targeted for future measure development.

    CMS states that it is already using measures from each of the core sets, and that it also "intends to implement new core measures across applicable Medicare quality programs as appropriate, while eliminating redundant measures that are not part of the core set." AHIP says that private insurers will use a "phased-in approach."

    While the collaborative unveiled its work on outcomes, APTA continued its own efforts to ensure that the physical therapy profession will be prepared to thrive in the coming health care landscape: earlier this month, the association announced the members of the scientific advisory panel that will guide the APTA Physical Therapy Outcomes Registry, a project that is anticipated to be the single largest repository of physical therapy outcomes data.

    News of the collaborative's measures was covered in the Huffington Post, The New York Times, and Medpage Today, among other outlets.

    As the need for outcomes data builds, so does the need for health care delivery systems that can strengthen those outcomes. In addition to its work on the Registry, APTA continues its Innovation 2.0 program, an initiative supporting research that bolsters the role of physical therapy in emerging health care models. Innovation 2.0 projects under way address pay-for-quality models, ACOs, PCMHs, and adding value in postacute care settings.


    • It would be extremely helpful if they would stop using BMI...a totally useless indicator...height, age, and weight do not necessarily tell you anything about percent body fat and lean mass...we use a bioelectric impedence device which measures body fat %, lean mass, and hydration index...it is an inexpensive tool and is considered the "silver standard"...I get annoyed when some muscular guy comes in and is classified as "overweight" because he is the same height, age, and weight as an out-of-shape guy who is genuinely overweight!

      Posted by Patti L. Schwartz on 2/24/2016 3:49 PM

    • http://www.businessinsider.com/body-mass-index-bmi-weight-fat-2015-7#ooid=Z4NzU5djq__t8XPNH6PK38bbslrx0Rmo

      Posted by Patti L. Schwartz on 2/24/2016 3:57 PM

    • More nonsense. Why don't the payors just admit we are being paid to collect data instead of treating patients. Someday WE will need care, and heaven help us all.

      Posted by Herbert Weiss -> >FW^@ on 2/24/2016 4:21 PM

    • I am sitting here in my living room at 10:27 PM checking a few emails. I cannot enter another outcome study after a > 10 hour office day. Will need to finish tomorrow. Example of the futility of these ".*#..@+" studies is the patient who is doing about 45% better functionally and in terms of pain by her calculations had a very poor showing on her outcome study. Happens all the time. I am all for demonstrating our effectiveness, but there has to be a more effective way of doing this. So many of the things patients want to tell us and the very important shades of gray are not on the outcome studies I have found. Oh and by the way, we are not being paid for the data collection and very poorly for the treatment, or maybe it is the other way around.

      Posted by Bonnie Cardenas on 2/25/2016 1:33 AM

    • Maybe we need to come up with some quality measures for payers...the door should swing both ways...

      Posted by Marsha Lawrence on 2/25/2016 10:36 AM

    • They may want to eliminate G codes in the outpatient realm as well. There was a study recently (last 12 months) in the journal Physical Therapy by Jette et al viewing the validity of these measures. G codes were not recommended based on having insufficient validity in determining status changes.

      Posted by David Ravnikar on 2/27/2016 9:31 AM

    • To echo Patti's comments above, does CMS realize that BMI has not been standardized for anyone over 55 years of age? The categories are for 55 and under, the information we are collecting and reporting on are useless for comparison.

      Posted by Eric Douglass on 3/1/2016 2:59 PM

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