Quality Measure Development

Tracking quality of care for vulnerable patients in post-acute and long-term care settings

Centers for Medicare & Medicaid Services (CMS)

As the main health care purchasers for millions of Americans, Medicare and Medicaid face a two-pronged challenge: providing quality care to patients while ensuring value for taxpayers. Meeting this challenge involves monitoring a diverse, wide-ranging, and changing landscape of health care providers.

The Centers for Medicare & Medicaid Services (CMS) is the agency in charge of this continuous evaluation process. Recognizing that individual patients follow different paths through the health care system—for example, being discharged from a hospital to either an inpatient rehabilitation facility or home-based care—the agency needs quality measures that can be applied uniformly to different settings. Quality measures allow providers to track patients’ symptoms and other indicators, such as the transfer of health information as patients move from one setting to another. This allows health professionals and regulators to identify performance gaps and areas for improvement, leading to better services throughout the system.

CMS chose RTI to develop quality measures for the growing post-acute care sector. Post-acute care facilities—inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home-health agencies—serve a vulnerable population of older adults. Since 2009, we have been working to develop measures of symptom management for certain components of the post-acute care sector. The results will help CMS improve the quality of care and the level of access to care for these patients.

Building on Health Care Knowledge and Specialized Technology to Ensure Interoperability

Our efforts to develop quality measures draw on our prior experience with CMS leading two significant projects focused on nursing homes, skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals, and hospices. Launched in 2014, the current combined project is a massive undertaking that RTI is uniquely suited to coordinate.

Our experts apply comprehensive knowledge of measure development, implementation, and maintenance to develop meaningful quality measures. To be meaningful, a quality measure must be both scientifically sound and clinically relevant—in other words, backed by evidence that improving a process will have a positive effect on patient outcomes.

A key standard for the new quality measures is interoperability—meaning they measure characteristics uniformly across different settings. Ensuring interoperability requires a solid background in health IT, which we have both the knowledge and the infrastructure to support.

To ensure that the measures we develop meet the needs of all stakeholders, we are leading a participatory process—inviting outside experts to join in a live meeting or teleconference to share their input on the measures, and posting draft measures on the CMS website for comment.

Under this effort, we are also helping train the providers who will be using the measures. We work with other CMS contractors to conduct about five training conferences each year.

Meeting America’s Need for Quality Measures that Make a Difference

One driver for the development of these quality measures was the IMPACT Act, the Improving Medicare Post-Acute Care Transformation Act of 2014. Under this legislation, providers will begin reporting data that capture interoperable quality measures across the post-acute care continuum—the measures we are developing. Some of the specific domains for which the IMPACT Act requires that we develop measures include skin conditions, cognitive function, and major falls.

To date, we have designed nine new measures to meet the requirements of the IMPACT act, while continuing to design and maintain approximately 50 other measures across all three provider settings.

The results will support public reporting on quality, resource use, and other factors in the performance of post-acute care providers. We strive to help CMS meet the intent of the IMPACT Act and other current and future legislation aimed at ensuring quality across the health care continuum.