This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Ambulatory Care Quality Alliance: Invitational Meeting
Mark McClellan, Centers for Medicare & Medicaid Services (CMS)
Mark McClellan opened his remarks with an observation that
there was great enthusiasm and sense of purpose behind the work that the Ambulatory Care Quality Alliance (AQA) had
achieved in the past year and the activities currently underway. He noted that
collaborative efforts are never easy, but added that with commitment tremendous
progress is possible. McClellan thanked all the attendees for their work and
their commitment to improving health care quality, singling out for thanks
Carolyn Clancy, the AQA steering committee, and the workgroup chairs.
We passed a
milestone in 2005 in the way that Congress and the public think about the work
we are doing, said McClellan. He noted that people are now looking at how
to provide better quality and not just debating whether it should be done. As a
result, he said, we are at a point where Congress is asking us to promote a
discussion of what a pay-for-performance system under Medicare would look like.
McClellan stressed that the effort is and must remain collaborative. He said he
was very pleased that the AQA includes people involved in primary care,
internal medicine, and a range of specialties.
recognizes an opportunity to make fundamental changes in health care, continued
McClellan. He stressed that Congress was interested in the AQA's work. We need
to get to a long-term, stable payment system, to avoid complications, and to
avoid unnecessary costs, he said.
to see more quality measures to help improve the health care system, added
McClellan. In fiscal year 2007, he said, hospitals and home health agencies
will receive a full market update if they hit quality measures. Those that
don't will receive less than a full update. McClellan noted that the Medicare
Modernization Act also includes some important provisions to push payment
reforms that support better payment systems and reduced costs.
Turning to the
topic of pilot projects, McClellan said Medicare gain-sharing would receive
funding in the coming year. He also said that there would be six demonstration
sites in the coming year designed to show how to raise the quality and
efficiency of care.
that the Medicare Modernization Act calls for a demonstration program for post
acute care payment. The idea, he explained, is to move to a system where a
beneficiary receives one comprehensive assessment when he or she is transferred
from acute care and when discharged. We ought to pay increasingly for what
works best, he stressed, and pay in such a way that we provide the flexibility
to get a patient into the right place of care.
touched on the progress of the systems design reviews. He said that despite a
lack of action on the issue from lawmakers, there was strong congressional
interest on the quality agenda and that he expected Congress to revisit the
issue soon. He added that Medicare
Payment Advisory Commission (MedPAC) has been asked to submit a report to Congress on ways to report
system design activities, and that CMS had been asked to comment on
improvements that would lead to a better payment system.
noted that there had been a number of questions from medical systems and
physician groups about how a new payment system might work. He said that CMS
was forging ahead in order to implement a system as soon as Congress approves a
new payment system. We expect to trigger higher payments within a couple of
business days of the law's passage, said McClellan, and we will try to make
payment changes retroactive to the beginning of the year. He added that his
agency has been working with the Office of the Inspector General to make sure
there would be no burden on physicians in collecting a differential copayment
rate from those who don't have supplemental insurance, and said that CMS
intended to reopen reenrollment for physicians to participate in Medicare.
Deficit Reduction Act, McClellan reiterated that there was a strong recognition
in Congress of the need to build on quality-related activities—and to move
within the current year to support and pay for it. Here we can make a strong
case for making quality measures, he said.
thanked the medical community for its engagement and support. It is not enough
for physicians to be on sidelines for effective changes to occur, he said.
Physicians and other health care professionals must lead the way. McClellan
also thanked participants for providing meaningful feedback on the physicians'
voluntary reporting program. As a result of that feedback, the number of
measures is down to 16 from 36, he said, and is starting in a way that is more
manageable for physicians participating in voluntary programs. He added that
CMS would continue to seek consensus on these quality measures.
As we put
quality measures into practice, continued McClellan, pilots and demonstration
programs will be essential steps for using quality measures and paying on that
basis. It is critical for AQA to work with CMS to move the demonstration
programs forward to shape the future of payment reforms in a way that works for
health professionals, he said.
interested in paying for reporting, said McClellan, and we are looking for
physician leadership and AQA leadership when Congress builds on existing
that CMS is implementing performance measures from the American Medical
Association in the demonstrations mandated by Sections 646 and 649 of the
Medicare Modernization Act. He pointed out that the hospital pilot has achieved
significant results, and that CMS was implementing other, similar demonstration
programs involving family medicine and surgical specialty groups.
that he was encouraged by forthcoming AQA pilot programs. These will yield
important lessons for reporting by physician practices and build a foundation
for future, large-scale programs, he said. He added that Phase I was scheduled
to be launched in the spring, and he said it would provide real-time data to
inform policy makers and Congress on next steps.
regional health information exchange programs, McClellan said the Indiana program
and others like it provide useful information about how to use data effectively
(particularly electronic data). While many physicians don't have electronic
medical records in place now, he added, we want to work with them so they will.
Next, McClellan thanked the AQA for developing efficiency
measures. He noted that one subgroup was looking for three sub-measure grouper
projects and said that CMS had evaluated the three predominant episode products
for use with the Medicare population. That report will be out in late spring,
his agency's strategic goals for 2006, McClellan said that CMS would continue
to emphasize these in order to improve health care in the United States. These
goals also need to be reflected in the way that we pay providers, he said.
McClellan noted that CMS was hoping to get useful stakeholder input (including
from AQA) into pay for performance and other options.
physician groups, McClellan added, AQA has done a lot of work developing
primary care measures. He added that it was important now to move beyond the
starter set. He outlined key areas in which CMS wanted to work with AQA. These
to develop and adopt measures of quality in a comprehensive way and to
work toward measures that will encompass a broader range of specialties.
measures important to other populations. As one example, McClellan cited
post-acute care, which accounts for significant Medicare spending growth.
He said CMS wants to work with physicians as the agency develops post
acute care demonstration projects, and that he wanted to see a measure for
care for frail populations.
improvements on measures already in use. McClellan cited the need for
quick progress on the practicality of data reporting to go hand-in-hand
with performance measurement. He also stressed the need to test and
improve physician feedback, stressing that if the system doesn't work for
physicians then it won't achieve widespread adoption.
AQA participants to keep the congressional timetable in mind and make real
progress in these four areas by Fall 2006. Congress will revisit physician
payments and Medicare payments this fall, he said.
McClellan said that CMS is counting on AQA participants in 2006 to get the
message out to physicians about the progress being made and the opportunities
to take advantage of pilot programs. This is the right time, with specialty
society leadership and momentum on quality, he said, for AQA to move its
efforts forward. McClellan committed CMS to providing the resources needed to
enable physicians to do what they do best. There is no doubt, he concluded,
that we can achieve goals in 2006 and that AQA will be instrumental in making
question-and-answer period began with a concern raised about the impact of
budget cuts on Medicaid and the State Children's Health Insurance Program
(SCHIP). It's hard not to feel cynical about quality measures for children, the
participant said, when the cuts are so draconian. In response, McClellan said
he was convinced that the statute gives CMS the authority to continue SCHIP
benefits and said he was committed to keeping it in place for everyone in the
Medicaid program. McClellan added that CMS would try to implement these
programs in such a way as to make sure there were no problems in accessing
care. He added that he had received some new ideas about a new waiver that
would make it possible to increase coverage outside the traditional Medicaid population.
remarked that Medicaid lagged behind in the way long-term care for the disabled
was structured. He said that long-term case wasn't just about nursing home
care, but that in fact many disabled people receive care in community settings.
He said the Deficit Reduction Act includes the most important provisions since
the Americans with Disabilities Act was passed to get people the long-term care
they prefer. It's time to move away from an institutional bias in Medicaid
care, he said.
noted that CMS had created “an unprecedented work pattern where CMS stands
shoulder-to-shoulder with workgroups so we meet your challenge.” This means,
she stressed, that CMS needs to commit to the effort and really get involved so
that physician groups, employers, and consumers can achieve the vision that you
have laid out.
McClellan acknowledged that it was easy to talk about the big picture and much
harder to implement it at the patient level. He reiterated that his staff would
give substantial time and effort to help AQA in its work. He also stressed his
hope to expand pilots and demonstrations, which he said were useful ways to
test pay-for-performance and other initiatives in development. Our goal is to
turn our vision into practical, real improvements that physicians see as
beneficial, he said.
thanked CMS for its work on quality measures, particularly in relationship to
the Hospital Quality Alliance (HQA). This is a really big step from a consumer
point of view, he said. In response, McClellan noted that the hospital quality
survey had problems, but succeeded because the kind of collaboration existed
that exists through AQA.
participant asked McClellan to share his observations on the recent Institute
of Medicine (IOM) report on improving performance. In response, McClellan noted
that much of the report focused on the role of Congress—but said that his view
was that much could be done without a congressional mandate. It's easier to get
the legislation we want if we make progress now, he said.
Carolyn Clancy, Agency for Healthcare Research and Quality (AHRQ)
opened her remarks by saying that a great deal of progress has been made in the
past 15 months, and that the leadership of many organizations has given
considerable time to AQA's efforts. She also noted the continued and growing
engagement of physician organizations.
Dr. Clancy pointed
out that a lot of the work happens between AQA meetings. The performance
measurement group, she said, has evaluated measures developed by the National
Committee for Quality Assurance (NCQA) and is taking a crack at developing
efficiency measures. Another workgroup is tackling the very important issue of
data aggregation. She noted that the Hospital Quality Alliance had a leg up
because it had an infrastructure in place for reporting to Joint Committee on
Accreditation of Healthcare Organizations (JCAHO); a counterpart does not yet
exist for most ambulatory care settings.
cited the recently released National Healthcare
Quality Report (NHQR) that
found a 9.2-percent increase in improvement on measures reported by hospitals.
Outside the hospital arena, however, there isn't that consistency. Clancy noted
that 60 percent of physicians practice in units of five or fewer—and that
capturing their data has been a challenge. She added, however, that pilots
slated to be launched in the spring should start to make this a reality.
strive to be transparent and uniform, concluded Clancy, and we are committed to
harmonizing requirements and to ensuring that private employers and health care
organizations are all using the same set of measures.
Previous Section Contents Next Section