Quality Initiatives - General Information

About CMS' Center for Clinical Standards & Quality

CMS' Center for Clinical Standards & Quality (CCSQ), led by the CMS Chief Medical Officer and the CCSQ Leadership Team, is a cadre of professionals with diverse backgrounds in clinical, scientific, public health, legal, IT, project management, academic, and business management fields. We serve CMS, HHS, and the public as a trusted partner with a steadfast focus on improving outcomes, beneficiaries' experience of care, and population health, while also aiming to reduce healthcare costs through improvement.

Read more about CMS' Center for Clinical Standards & Quality in the Downloads section, below. 

About CMS' Quality Initiatives

Quality health care for people with Medicare is a high priority for the President, the Department of Health and Human Services (HHS), and the Centers for Medicare & Medicaid Services (CMS). HHS and CMS began launching Quality Initiatives in 2001 to assure quality health care for all Americans through accountability and public disclosure.

The various Quality Initiatives touch every aspect of the healthcare system. Some initiatives focus on publicly reporting quality measures for nursing homes, home health agencies, hospitals, and kidney dialysis facilities. Consumers can use the quality measures information that is available on www.medicare.gov for these healthcare settings to assist them in making healthcare choices or decisions.

Request for Information Issued for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

The Centers for Medicare & Medicaid Services (CMS) announced today a Request for Information (RFI) for the Medicare Access and CHIP Reauthorization Act  of 2015 (MACRA). There will be a 30-day opportunity for responses.

This RFI seeks public comment on Section 101 of MACRA, which is subject to notice and comment rulemaking. Section 101 repeals the Medicare Sustainable Growth Rate (SGR) methodology for updates to the physician fee schedule (PFS) and implements scheduled PFS updates, including a higher update rate for “qualifying participants in Alternative Payment Models (APMs)” beginning in 2026.

Section 101 also adds the new Merit-based Incentive Payment System (MIPS) for eligible professionals (EPs), sunsets payment adjustments under the current Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), and the Medicare Electronic Health Records (EHR) Incentive Program, often referred to as the Meaningful Use (MU) program, and consolidates aspects of those programs into the new MIPS.

In addition, Section 101 of the MACRA promotes the development of APMs by providing incentive payments for certain EPs who participate in APMs and by encouraging the creation of additional Physician-Focused Payment Models (PFPMs).

• The Request for Information and instructions about how to respond are available at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-24906.pdf.

• For an informative and pertinent discussion on the Path to Value in health care, see MACRA: New Opportunities for Medicare Providers Through Innovative Payment Systems by Patrick Conway (and others) in Health Affairs.

• The complete Medicare Access and CHIP Reauthorization Act of 2015 can be viewed at https://www.congress.gov/bill/114th-congress/house-bill/2/text.

Request for Information: Transforming Clinical Practices

The Center for Medicare & Medicaid Services (CMS) seeks information about large scale transformation of clinician practices to accomplish our aims of better care and better health at lower costs. Practice Transformation is a process that results in observable and measurable changes to practice behavior. 

These behaviors include core competencies: Engaged leadership and quality improvement; Empanelment  and improved patient health outcomes; Business and Financial acumen ;Continuous and  team-based healing relationships that incorporate culture, values, and beliefs; Organized, evidence-based care; patient-centered interactions; Enhanced access; progression toward population based care management; State-of-the-art, results-linked, care; Intentional approach of practices to maximize the systematic engagement of patients and families; and Systematic efforts to reduce un-necessary diagnostic testing and procedures with little or no benefit.

CMS seeks responses to questions listed in Request for Information (RFI) which can be accessed through the download below.  CMS may use this information collected through this RFI notice to test new payment and service delivery models. Please take the opportunity to respond to the questions most appropriate for your organization.  All comments are requested in the described format to the designated CMS representative noted in the RFI by 11:59 pm Eastern on April 8, 2014.

CMS Quality Strategy

We are pleased to announce the CMS Quality Strategy, which is built on the foundation of the CMS Strategy and the HHS National Quality Strategy (NQS). The CMS Quality Strategy pursues and aligns with the three broad aims of the National Quality Strategy and its six priorities. Each of these priorities has become a goal in the CMS Quality Strategy. To learn more about the CMS Quality Strategy, and to provide feedback and public comment, please click on the following link: CMS Quality Strategy

Physician Quality Reporting Programs Strategic Vision

The Physician Quality Reporting Programs Strategic Vision (or “Strategic Vision”) describes a long-term vision for CMS quality measurement for physicians and other health care professionals and public reporting programs, and how they can be optimized and aligned to support better decision-making from doctors, consumers, and every part of the health care system.  This Strategic Vision articulates how we will build upon our successful physician quality reporting programs to help achieve the CMS Quality Strategy’s goals and objectives, and therefore contribute to improved healthcare quality across the nation.  Access the Strategic Vision by clicking this link: Physician Quality Reporting Programs Strategic Vision (PDF)

Quality Improvement Organizations

Successful quality initiatives rely on partnerships and support from many sources that encompass the healthcare community such as federal and State agencies, researchers and academic experts, stakeholder and consumer organizations, providers and advocates, and federal contractors such as Quality Improvement Organizations (QIOs). QIOs can assist Medicare beneficiaries and their caregivers understand and use quality measures information in their healthcare decision making process. For more information about QIOs or CMS survey and certification activities, see the "Related Links" section, below.

Quality Measures

CMS has developed a standardized approach for the development of quality measures that it uses in its quality initiatives. Known as the Measures Management System (MMS), this system is composed of a set of business processes and decision criteria that CMS funded measure developers follow in the development, implementation, and maintenance of quality measures. The steps in the measure development process are summarized in the document "Quality Measures Development Overview," which is available as a downloadable file in the "Downloads" section, below.

Post Acute Care Reform Plan

CMS funded a project to review assessment approaches that could be used across post-acute settings to reduce care fragmentation and unsafe transitions, and to compare outcomes and costs for patients discharged to post acute care. The report entitled 'Uniform Patient Assessment for Post Acute Care (PAC) Final Report' and a stand alone executive summary are available in the Downloads section, below. It should be noted that the content of this report does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of any trade names, commercial products, or organizations imply endorsement by the U.S. Government. CMS has developed a plan to improve Medicare's payment for post-acute care services and the coordination of these services. Post-acute care is care that is provided to individuals who need additional help recuperating from an acute illness or serious medical procedure.

Development of Quality Indicators for Inpatient Rehabilitation Facilities (IRFs)

The overall goal of this project was to assist CMS in developing appropriate measures to monitor and evaluate the quality of rehabilitation services provided to Medicare beneficiaries in IRFs. The key questions addressed by this report include: What are the expected outcomes of an inpatient rehabilitation stay? What factors affect those outcomes? Do we have appropriate measures of those relationships? And if not, what measures do we need? Funded by CMS, in considering these key questions, Research Triangle Institute (RTI) incorporated expertise from the field of physical medicine and rehabilitation services to develop measures specific to the rehabilitation field that would target these issues while still minimizing the administrative reporting burdens for providers. The report and its accompanied appendices are available in the Downloads section, below.