Quality Measures – BIG NEWS!

quality matters word abstractThe 2016 “Prior Year Benchmarks” report is out for measures included in the 2016 “Quality and Resource Use Reports” (QRUR). There is HUGE news for wound care and hyperbaric medicine but no one has talked about it yet. THIS IS BIG.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/PY2016-Prior-Year-Benchmarks.pdf

It’s going to take a lot of blog entries to cover all the ways that this will impact wound care and hyperbaric medicine. For once, there’s good news, so don’t reach for a Prozac, but as always, it’s complicated. As I have explained before, the QRUR is the report that positions clinicians on a grid in relation to their quality measure score (higher is better) vs. the Medicare dollars spent on their patients (lower is better).

The old system of three different incentive programs (PQRS, MU and Value and Resource Use) ended in 2016. The new system of the Merit Based Incentive Payment System (MIPS) started this past January 1, 2017. For a practitioner to have a chance at a bonus payment, he or she has to end up in the top performance decile of all the practitioners reporting any one measure. That’s why the benchmarking rates for each measure are important. If there is no national rate for a measure, it can’t contribute to your quality score. That’s the drawback to quality measures created by Qualified Clinical Data Registries (QCDRs). QCDRs are doing important work developing measures that are really needed in areas like wound care that CMS has overlooked, but until enough practitioners report a measure for a national benchmark to be established, it doesn’t “count” for the practitioners who reported it.

Quality reporting is like the exams we had in college or medical school that were graded on a curve. You can’t look at your score and know how well you did. I remember getting back a college calculus exam with a grade of 46 and thinking, “Well, now I have to bring up an F,” only to find out that I made a B+ because the test was graded on a curve and a score of 50 was an “A.” Quality reporting scores work like that. Depending on the measure, a score of 50% could put you in the bottom decile or the top decile because it’s calculated in relation to everyone else reporting that measure.

You can open the link above and see the benchmark rate for every measure that can be used in 2016 as part of your QRUR. There’s a lot of really important information in this report. The USWR has been working hard to get enough practitioners through as many of our QCDR measures as possible in the past 2 years so that we could set some benchmark rates. If a QCDR measure has no data reported at all in this report, it means one of 2 things:

  • It has not been reported by any provider EVER (unused)
  • It has not been reported by ENOUGH providers to get a benchmark, but benchmarks for it MIGHT be available next year

The document in the link lists quality measures by measure name, in alphabetical order. That means the USWR hyperbaric and wound care measures are spread out in several different places, so I have included page numbers below. I’ll talk about all the relevant measures in future posts. However, for this blog I am going to make an announcement that has been a decade in the making.

Ten years ago, I set out with the help of Marcia Nusgart and the Alliance of Wound Care Stakeholders to develop CMS recognized quality measures for wound care practitioners. It seemed an impossible, David vs. Goliath battle. Today, a decade later, I am announcing that the USWR has national benchmark rates recognized by CMS for the following measures (and others in addition):

  • Vascular assessment of patients with leg ulcers- 52.91% (CDR 10: page 16)
  • Adequate off-loading of diabetic foot ulcers- 56.96% (CDR 1: page 17)
  • Adequate compression of venous leg ulcers at each visit: 88.65% (CDR 5: page 17)

I will talk about additional USWR wound care measures that have benchmarks in my next blog post. Right now, I want to explain why this is  a HUGE event. Firstly, when the USWR looked at registry data 7 years ago (2010) we found that only about 2% of DFUs received adequate off-loading at each visit (and a smaller percentage of those were total contact casting), with only 17% of VLU patients receiving adequate compression. While we did not report the percentage who got vascular screening, it was less than 10%.

We can now say that among the practitioners who reported the above measures, the gap in practice for these interventions has been significantly reduced. While improved patient care is something to be excited about, the big news story is that because there is a national benchmarking rate, IN 2017, PRACTITIONERS CAN REPORT THESE MEASURES UNDER MIPS FOR QUALITY MEASURE CREDIT. BECAUSE THE BENCHMARK RATE HAS BEEN SET, YOU KNOW THE RATE YOU HAVE TO BEAT IN ORDER TO HAVE A CHANCE AT BONUS PAYMENTS. If there is no benchmark rate, you can’t use the measure among your six measures for possible bonus money under MIPS.

So, I am taking a victory lap today. I am saying an official “thank you” to the Alliance of Wound Care Stakeholders and the people who were on those conference calls in 2013 when we created these measures. You know who you are. Most of the individuals were from the Association for the Advancement of Wound Care (AAWC) and the American Professional Wound Care Association (APWCA) with the Alliance facilitating the calls for the US Wound Registry.

This has been expensive. In 2014, the USWR, a 501 (c)(3) non-profit organization, got some small financial donations from a few manufacturers, but it has no ongoing financial support from any of the clinical wound care association whose members it serves, from any management company, or from any manufacturer. This is an issue that continues to baffle me, but that’s a topic for another day.

Despite the odds and the absence of funding for the work, the USWR managed to create benchmark rates for the 3 most basic processes in wound care, just in time for MIPS. To the wound care practitioners who reported this measure, the entire industry owes you a debt of thanks. Today is a great day.

Fife, C. E., Carter, M. J. and Walker, D. (2010), Why is it so hard to do the right thing in wound care?. Wound Repair and Regeneration, 18: 154–158. doi:10.1111/j.1524-475X.2010.00571.x


Caroline Fife, MD    Twitter Facebook  |  LinkedIn

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