As a growing number of federal programs incorporate elements of the Universal Foundation of quality measures, initiated by the Centers for Medicare & Medicaid Services (CMS) in 2023 to create a more uniform set of standards across all CMS programs, the Texas Medical Association looks to address the ongoing rollout’s impact on physicians.
As alternative payment models proliferate, quality measures are used to evaluate patient care and practice efficiency – and in some cases, determine payment amounts.
“Over the years, we all have recognized that there’s a quality-measure proliferation,” said Padmaja Patel, MD, a member of TMA’s Committee on Alternative Payment Models. “It makes it very hard for clinicians to report when participating in different programs.”
The Universal Foundation’s rollout demonstrates CMS is aware of physicians’ ongoing issues with quality measures, says the Midland internist and president of the American College of Lifestyle Medicine.
Universal Foundation measures are increasingly replacing previously established measures in CMS programs that Texas physicians are either already enrolled in or may be considering. To best serve patients and physicians, TMA aims to formulate policy with appropriate guidelines.
TMA’s Council on Health Care Quality and Committee on Alternative Payment Models finalized a joint report on Feb. 7, which delegates at this year’s TexMed conference will consider for approval.
Positing “quality measurement can improve care only when it is fair, clinically meaningful, and practical for physician practices,” the joint report presents six principles the Universal Foundation quality measures should strive for:
- Promoting meaningful outcomes;
- Advocating for equitable and accurate risk adjustment;
- Protecting appropriate use of measures;
- Accounting for practice realities;
- Requiring meaningful collaboration (between CMS and organized medicine); and
- Promoting true multipayer alignment.
That final plank calls on CMS to “work with the Texas Health and Human Services Commission and commercial health plans to achieve multipayer alignment of quality measures so that physicians are not subject to multiple, competing reporting systems, and encourage the Texas Legislature to support policies that promote such alignment.”
Lindsay Botsford, MD, chair of the Council on Health Care Quality, says that principle is crucial, as it reaches beyond the CMS services already using Universal Foundation measures.
“For many practices, Medicare or Medicaid patients are only a fraction of the population,” she said. “The Universal Foundation solves some of the problems for that population, but there’s still misalignment with other approaches by other payers.”
TMA’s report acknowledges Universal Foundation’s goal is to “replace hundreds of fragmented, program-specific measures with a smaller, more consistent set that focuses on what matters most to patients and clinicians,” an aim with which both Dr. Patel and Dr. Botsford agree.
“In the CMS world, there were over 20 different quality programs that someone could participate in across various settings, and there weren’t even always consistent, so the burden on physicians and on physician organizations for reporting has been high,” Dr. Botsford said.
“It’s definitely the step in the right direction,” Dr. Patel added. “It’s really important for clinicians to understand CMS will adopt this across more and more programs.”
The initiative is intended for all CMS programs, including Medicare, Medicare Advantage, Medicaid, the Children’s Health Insurance Program (CHIP), marketplace plans, and Innovation Center models. Visit TMA’s Medicare Access and CHIP Reauthorization Act Resource Center for more information about Quality Payment Program (QPP) participation, including deadline updates and free QPP resources.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.