This week, America's Health Insurance Plans (AHIP) and its members, as part of a collaborative effort with the Centers for Medicare and Medicaid Services and National Quality Forum announced the release of seven core sets of quality measures that will help to align quality improvement and reporting across the health system including public and private payers. Core quality measure sets were released in accountable care organizations/patient centered medical homes, cardiology, gastroenterology, HIV/Hepatitis C, medical oncology, orthopedics, and obstetrics and gynecology.
More information about the announcement from AHIP can be found here:
More information about the announcement from CMS can be found here:
Although ACOG representatives did participate in the process to select measures to be included in future pay-for-performance/value-based physician and hospital contracts, ACOG did NOT choose to be recognized for participation until further agreement can be made regarding balancing the physician and hospital payment-tiering programs for the core set for obstetrics and gynecology with health insurance plan level measurement of long-acting reversible contraception rates and moderately effective contraception rates, and postpartum contraception rates. ACOG supports the concept of measure harmonization and alignment across payers, but believes effective contraceptive access and moving to clinical data (from claims-alone) for performance measures are critical to advance health care for American women. ACOG representatives successfully addressed the limitations and inutility of 3rd and 4th degree lacerations and cesarean sections as clinical performance measures. Discussion items such as commercial administrative claims data being matched with clinical data in vital statistics and low volume thresholds/minimum sample sizes, provider attribution methodologies, and data quality auditing remain outstanding.
All of the measures in the core set for obstetrics and gynecology are vetted and endorsed by the National Quality Form. Most are already used in the voluntary CMS Adult Medicaid and CHIPRA Core Measure Sets or for accreditation by The Joint Commission. Ob-gyn practice and hospital leaders, practice managers and others involved in commercial health insurance payer negotiations should make sure to address low volume thresholds/minimum sample sizes and plan’s data quality auditing to ensure the measures included in future contracts fit your patient population and practice.
Ob-gyns with practices who have health data privacy concerns for their patients, especially adolescents and dependent patients under 26 should be aware of the HIV/Hepatitis C Core Measure Set’s non-NQF endorsed measure "HIV Screening of STI patients: Percentage of patients diagnosed with an acute STI who were also tested for HIV."
Ob-gyns involved in accountable care organizations or patient centered medical homes should also take a look at the ACO/PCMH Core measure Set.
ACOG representatives continue to collaborate with the AHIP, CMS, and NQF on the development of the core measure sets. Members with concerns about the individual measures or this initiative can submit inquiries to firstname.lastname@example.org.
As most of the measures are based on health insurance plan claims data, it is recommended that outpatient practices address their billing and coding data quality through continuing education.
ACOG's coding workshops can be found here:
ACOG's coding webcasts can be found here: