Still No Medicare Quality Measures for Clinical Laboratories and Pathology Groups

Transparency in provider outcomes is moving one step forward and this time it’s a new bonus plan for Medicare Advantage plans. The Centers for Medicare and Medicaid Services (CMS) believes the enhancement will encourage lower performing plans to improve their quality of care.

Quality Measures Should Interest Medical Laboratory Managers

Pathologists and clinical laboratory managers will be interested to learn that, during the 3-year demonstration project, bonuses of 5% will be paid to Medicare Advantage plans that achieve a 5-star rating. Lesser bonuses will be paid to those plans that achieve three to four stars. A new twist is that this update also includes a new “low performer” icon to alert Medicare Advantage recipients of plans that earn less than three stars over a 3-year period.

“The 5-star rating system helps people with Medicare make meaningful distinctions between high-performing and low-performing health plans. They also allow plan sponsors to see how they compare to other plans and encourage them to improve care and customer service, so their plans are more attractive to Medicare beneficiaries,” said CMS Administrator Donald M. Berwick, M.D., in a CMS press release. “The demonstration rewards high performers more than low performers, creating an incentive for all performers to improve.”

CMS tracks 53 quality measures. These measures range from chronic disease management and consumer complaints to preventative care. These 53 quality measures are used by CMS to determine how many stars to assign to specific Medicare Advantage plans.

Medicare Trend of Increased Provider Transparency Continues

It is notable that, under the Obama administration, CMS continues to press for greater transparency in the outcomes of hospitals, physicians, and health insurance plans. This is a policy direction that began under President Bush. Price controls continue to be linked to outcomes, which continue to drive reimbursement rates. These are incremental steps that advance transparency of provider outcomes for Medicare beneficiaries, but are understood to be implementation of major policy.

Pathologists and medical laboratory managers should see these signs as further incremental steps toward full transparency in provider outcomes. At some point, CMS is likely to implement transparency measures that involve clinical laboratories and anatomic pathology groups.

Related Information:

Medicare Announces Quality Bonus Payment Demonstration for Medicare Health Plans

Detailed Information on This Year’s Current And Previous Ratings Scores