Quality Measure Overhaul Relies on Lab Results

The Centers for Medicare and Medicaid Services (CMS) took another step in its march toward paying for value versus volume, releasing seven sets of new healthcare clinical quality measures. CMS worked on the quality measures with America’s Health Insurance Plans (AHIP), the National Quality Forum, physician groups, and other stakeholders so that public and private payers can agree on how to measure—and eventually how to reward—quality care. According to CMS, this work will inform the agency’s implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) during the rulemaking process. The seven sets of measures include accountable care organizations, patient-centered medical homes, and primary care; cardiology; gastroenterology; HIV and hepatitis C; oncology; obstetrics and gynecology; and orthopedics. The goals were to streamline what was becoming a complex system of reporting for providers and to enable easy comparisons for policymakers, patients, regulators, and insurers.

Many of the quality measures depend on laboratory testing. For example, primary care-related quality measures include: HbA1c testing and the percentage of patients with results >9%; the percentage of women who’ve had recommended cervical cancer screening or non-recommended screening; and the rate of colorectal cancer screening. Under HIV/HCV care, measures include screening for chlamydia, gonorrhea, and syphilis; HIV screening for patients with an acute sexually transmitted infection; and HCV screening for at-risk patients. Measures for oncology include KRAS gene mutation testing for patients with metastatic colorectal cancer who receive anti-epidermal growth factor receptor monoclonal antibody therapy, as well as appropriate treatment for patients with breast cancer based on HER2 status. Screening for cervical cancer and chlamydia are included under obstetrics and gynecology. The CMS-AHIP collaboration plans to release new measure sets and update current sets over time.

CMS said it already is using some of the quality measures in its various Medicare quality programs, and commercial health plans are expected to implement them when contracts come up for renewal or if existing contracts allow modification of the performance measure set.

Obama’s Budget would Boost Biomedical Research

President Obama’s 2017 budget would boost funding to several biomedical initiatives. Overall, the budget provides $33.1 billion, including an additional $1.8 billion in mandatory funding, to the National Institutes of Health. But the budget also adds additional monies for three of the president’s signature initiatives: precision medicine, cancer research, and the BRAIN initiative.

For the president’s precision medicine initiative, the budget includes $300 million for NIH to “[accelerate] research into the development of treatments tailored to specific characteristics of individuals.” The budget supports efforts underway to establish a voluntary national research cohort of 1 million or more Americans, expand research to define cancer subtypes and identify new therapeutic targets, modernize the regulatory framework for DNA sequence-based diagnostic tests, and improve data sharing and interoperability.

Another $195 million from the budget goes to the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative. The initiative has grown since its launch in 2013 to include five agencies, and dozens of major foundations, private research institutions, universities, companies, and advocacy organizations, according to the administration.

In a break with tradition, Senator Michael Enzi (R-Wyoming), chairman of the Senate Budget Committee, and Representative Tom Price (R-Georgia) announced they would not invite the president’s budget director to testify before their respective panels. Leaders from neither party have indicated when Congress might consider its own budget resolution for 2017.