News: CMS must do a better job monitoring quality programs and funding, GAO says

The Government Accountability Office (GAO), a government watchdog agency, said in a recent report that CMS lacks complete information on how much funding it allocates for quality programs. Additionally, the GAO questioned whether CMS has the procedures in place to ensure quality measures meets objectives for the program, according to FierceHealthcare.  

The failings, according to the GAO, could have far reaching consequences because private payers often adopt CMS quality measures for commercial plans as well.

Each quality measure CMS adopts must meet eight strategic objectives that include whether the measure is outcomes-based, patient-centered, and aligns with other programs. But according to the GAO, CMS doesn’t do a good job of determining whether the adopted measures actually meet these examples.

For example, the GAO cited the fact that last year, CMS’ quality programs had no measures that addressed the “high-impact” area called “equity of care,” and 13 out of 17 quality programs had no measures addressing “community engagement,” according to FierceHealthcare. Both categories would fall under the heading of population health.

The report also claims that CMS hasn’t developed performance indicators to determine if a measure makes progress on a strategic objective.

The GAO also raised concerns about how CMS allocates funding for quality programs. Their analysis found that CMS has a large amount of funding allocated for quality programs that hasn’t been used. For example, in fiscal year 2018, the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act quality programs had an unspent budget of $42 million, FierceHealtcare reported.

In conclusion, the GAO recommended that CMS

• Maintain more complete and detailed information on its funding for quality measurement activities
• Establish procedures to systematically assess measures under consideration based on CMS’ quality measurement strategic objectives
• Develop and use performance indicators to evaluate progress in achieving its objectives

The Department of Health and Human Services concurred with the recommendations, according to the report.

Editor’s note: To read the full GAO report, click here. To read FierceHealthcare’s coverage of this story, click here. For more information on population health initiatives and CDI’s role, click here.