National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Reports

CMS uses quality measures to support a patient-centered health care system anchored by quality, accessibility, affordability, innovation, and accountability. The National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Reports (Impact Assessment Reports) examine data-driven results that support progress toward CMS objectives to improve public health, implement measures meaningful to patients and providers, minimize provider burden, focus on outcomes whenever possible, identify significant opportunities for improvement, and support a transition to population-based payment models. These triennial reports are required by section 1890A(a)(6) of the Social Security Act.

2024 Report

CMS analyzed quality measure results from 2016 to 2021 across 26 quality and value-based incentive payment programs. Findings show that improvements in measure performance, largely prior to the coronavirus disease 2019 (COVID-19) public health emergency (PHE), were associated with positive impacts for millions of patients and substantial costs avoided. Then, in 2020 and 2021, COVID-19 created challenges for most health systems that limited capacity to sustain improvement, and a large proportion of measures had worse performance than expected from baseline trends.

Health equity is a goal of the CMS National Quality Strategy and a central focus of this report, which identified persistent health disparities for the vast majority of measures analyzed.

Focus groups representing historically disadvantaged populations were also convened. Their perspectives underscore the critical need to develop equity measures that address bias in care delivery and deficits in cultural competency, as well as social drivers of health relative to unmet health needs, poor access, and low health literacy.

The report also provides updates on how CMS is optimizing the measure portfolio and reducing burden through broad use of digital data sources and alignment of measures across programs, settings, and federal agencies.

Download the 2024 National Impact Assessment Report (PDF) and the 2024 National Impact Assessment Report Appendices (ZIP).

2021 Report

The 2021 National Impact Assessment of CMS Quality Measures Report includes a careful analysis of the quality measures used in 26 CMS quality programs. The report demonstrates substantial improvements in quality of care, cost efficiency, and burden reduction, as well as reflects positive survey feedback on measures impact.

Key findings of the report include:

• A 24% reduction in the number of measures used in CMS quality programs.
• Increased focus on outcomes measures, which increased from 39% to 46% of total measures since 2015.
• Significant costs avoided calculated for a small subset of 15 Key Indicator measures, yielding total estimates ranging from $29.6 billion to $51.9 billion.
• 34% of Key Indicator measures analyzed with baseline disparities showing improvement in at least one measure performance comparison.

2018 Report

CMS used multiple analyses of measure performance trends, disparities, patient impact, and costs avoided, as well as national surveys in hospital and nursing home quality leaders, to evaluate the national impact of the use of quality measures. Key Indicators were selected from CMS measures with input from a Technical Expert Panel and a Federal Assessment Steering Committee to assess national performance regarding the CMS quality priorities of patient safety, person and family engagement, care coordination, effective treatment, healthy living, and affordable care. Highlights include these main findings:

• Patient impacts estimated from improved national measure rates indicated approximately:
  • 670,000 additional patients with controlled blood pressure (2006–2015).
  • 510,000 fewer patients with poor diabetes control (2006–2015).
  • 12,000 fewer deaths following hospitalization for a heart attack (2008–2015).
  • 70,000 fewer unplanned readmissions (2011–2015).
  • 840,000 fewer pressure ulcers among nursing home residents (2011–2015).
  • 9 million more patients reporting a highly favorable experience with their hospital (2008–2015).
• Costs avoided were estimated for a subset of Key Indicators, data permitting. The highest were associated with increased medication adherence ($4.2 billion–$26.9 billion), reduced pressure ulcers ($2.8 billion–$20.0 billion), and fewer patients with poor control of diabetes ($6.5 billion–$10.4 billion).
• National performance trends were improving for 60% of the measures analyzed, including a majority of outcome measures, and were stable for about 31%.
• Overwhelmingly, hospitals (92%) and nursing homes (91%) surveyed reported they consider CMS measures clinically important. Likewise, 90% of hospitals and 83% of nursing homes agreed that performance on CMS quality measures reflects improvements in care. Respondents also described barriers to reporting, including burden; barriers to improving performance; and unintended consequences of CMS measures.
• Disparities by race/ethnicity, income, sex, rural versus urban, and region were identified. The highest percentages of measures with disparities were observed for the following groups: Black (41%), Native Hawaiian/Pacific Islander (46%), Hispanic (37%), low income (42%), noncore or rural (23%), and West North Central region (26%).

2015 Report

The 2015 Impact Assessment Report encompasses 25 CMS programs and nearly 700 quality measures from 2006 to 2013 and employs nine key research questions.  A Technical Expert Panel of quality measurement leaders from across the health care industry and a Federal Assessment Steering Committee consisting of stakeholders from CMS and other U.S. Department of Health and Human Services (HHS) agencies were convened to provide input into the report. 

2012 Report

For the March 2012 report, CMS assessed the impact of quality measures within two categories:

• Implemented measures with at least two years of performance information between 2006 and 2010.
• Measures under consideration by CMS and made available to the public in December 2011.

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