A provision that would allow CMS-approved Qualified Clinical Data Registries (QCDRs) to use quality measures without paying licensing fees to the QCDRs that develop and maintain those measures was the top concern among PCPI members responding to the 2019 Quality Payment Program rule proposed by HHS. Shortening the four-year schedule for retiring quality measures from the Merit-based Incentive Payment System (MIPS) when they achieve near-100 percent compliance was the second biggest issue members had with the proposed rule.
PCPI made the case for changing these and other member issues in its comment letter on the proposed rule, filed with HHS on September 10. The effort kicked off a new structured process that PCPI designed to proactively involve members in developing comments, ensuring that PCPI identifies important member issues and presses them with federal regulators.
As organizations that develop and maintain clinical quality measures, PCPI members objected to the licensing provision for two reasons. First, allowing QCDRs to adopt measures without oversight from the organizations maintaining them threatens measure integrity. Without supervision, measures may be incompletely or improperly implemented, reducing their effectiveness. Further, reported results may not be accurate, complicating analysis of measure performance and potentially even leading to premature retirement.
Second, allowing measure use without license fees threatens the financial sustainability of QCDRs. Medical societies and other developers spend large sums and devote significant specialized expertise to produce measures. Without the possibility of compensation through licensing fees, fewer measures can be developed and this provision will continue to perpetuate the unfunded mandate for specialty-focused measure development.
Regarding early retirement of topped-out measures, members noted that near-complete compliance among reporting physicians may not reflect broader compliance because physicians select which measures they report and tend to report those they can meet. PCPI recommended that CMS instead require physicians to stop reporting a measure after achieving 98-100 percent compliance for three consecutive years.
Other issues addressed in the comment letter included:
- The proposed removal of specific quality measures from the MIPS program
- Assigning value to quality measures for purposes of refining the scoring model
- Excluding topped-out measures used in QCDRs from the existing topped out measure timelines
PCPI supported CMS’ proposal to modify the definition of a QCDR to an entity that has both clinical and quality measurement development expertise, and to broaden the range of improvement activities (IA) in the 2019 IA Inventory. See our full comment letter here.