Developing Pathology Measures for the Quality Payment Program-Part II: Overcoming Challenges With Data Capture to Maximize Reimbursement.

CONTEXT.­: Quality measures are a cornerstone in measuring physicians' performance within the Centers for Medicare & Medicaid Services' Quality Payment Program (QPP). Clinicians' performance on quality measures and other categories within the QPP determines Medicare part B payment adjustments. Driven by evidence-based clinical practice guidelines, quality measures should focus on high-priority facets of health care, support a desired patient outcome, and address an area with evidence of a gap or variation in provider performance. OBJECTIVE.­: To meet the goals of the QPP, a broad array of quality measures must be developed that allows pathologists the flexibility to choose activities and measures most meaningful to their practice and patient population while also trying to mitigate the challenges of implementation and data collection. DESIGN.­: In this second manuscript of the series, we present the development of additional College of American Pathologists-developed quality payment measures for use in the QPP. We also discuss the relationship of quality measure reporting with reimbursement and the challenges with capturing data for quality reporting. RESULTS.­: The College of American Pathologists identified 23 new measures for quality performance reporting that reflect rigorous clinical evidence and address areas in need of performance improvement. CONCLUSIONS.­: Development of quality measures is a necessary and ongoing effort within the College of American Pathologists. Increased awareness about pathology-specific issues in measure development and reporting is essential to ensuring pathology's ability to demonstrate value and meaningfully participate in the QPP.

Developing Pathology Measures for the Quality Payment Program-Part I: A Quest for Meaningful Measures.

CONTEXT.­: Quality measures assess health care processes, outcomes, and patient perceptions associated with high-quality health care, which is commonly defined as care that is effective, safe, efficient, patient centered, equitable, and timely. Such measures are now being used in order to incentivize provision of high-quality health care. OBJECTIVE.­: To meet the goals of the Quality Payment Program, quality measures will be developed from clinical practice guidelines and relevant, peer-reviewed research identifying evidence that the measure addresses 3 areas: a high-priority aspect of health care or a specific national health goal or priority; a meaningful focus, such as leading to a desired health outcome; and a gap or variation in care. DESIGN.­: Within the College of American Pathologists (CAP), the Measures and Performance Assessment Subcommittee is tasked with developing useful performance measures. Participating practitioners can then select measures that are meaningful to their respective patients and practices, and reflect the quality of the services they provide. RESULTS.­: The CAP developed 23 quality measures for reporting to the Centers for Medicare & Medicaid Services that reflect rigorous clinical evidence and address areas in need of performance improvement. CONCLUSIONS.­: Because the implications of reporting on these pathology-specific metrics are significant, these measures and the process by which they were designed are presented here in peer-reviewed fashion. The measures described in this article (part 1) represent recent efforts by the CAP to develop meaningful measures that reflect rigorous clinical evidence and highlight areas with opportunities for performance improvement.

Updates to Medicare's Quality Payment Program That May Impact You.

CONTEXT.­: Within Medicare's Quality Payment Program, and more specifically the Merit-based Incentive Payment System, pathologists stand to potentially lose or gain approximately $2 billion during the initial 7 years of the program. If you or your group provides services to Medicare beneficiaries, you will likely need to comply with the program. OBJECTIVE.­: To avoid potential reductions in Medicare reimbursement, pathologists need to understand the requirements of these new payment programs. DATA SOURCES.­: Each year the Centers for Medicare & Medicaid Services publish a Final Rule detailing the program requirements and updates. 2020 marks the fourth reporting year for the Merit-based Incentive Payment System. Performance this year will impact 2022 Medicare Part B distributions by up to ±9%. CONCLUSIONS.­: By staying up to date with the ever-evolving Merit-based Incentive Payment System requirements, pathologists will be better equipped to successfully comply with this relatively new payment system, reduce the burden of participating, understand the reporting differences of the various performance categories, and thereby be able to maximize their scoring and incentive potential.