Resource Directory

Health care organizations—from individual family physicians to university health systems and health plans—all shoulder the costs of quality measure reporting. A large health system spent over $5.6 million on quality reporting in 2018, with over $600,000 paid to vendors to report and share quality data, and including more than 100,000 hours of health care staff time.

Quality measurement and reporting requires significant staff effort and expense because of the manual processes involved in the collection, exchange, management and analysis of health care data. A report found that clinicians bear a significant proportion of the cost of quality measurement reporting—an estimated $15.4 billion—including for chart abstraction, data validation and measure reporting. Other industries have leveraged modern information technology to reduce these costs of data management.

Quality measurement is the application of standardized quality measures to evaluate the health outcomes and experiences of care provided to individuals and populations, as well as the structures and processes used by organizations and clinicians to deliver care. The results of quality measurement guide quality improvement and can be used in accountability and value-based purchasing programs.

As Congress continues to advance price transparency and value-based care, dQMs can revolutionize consumer choice. Through combined price and quality outcomes, consumers can get a true picture of the value of their care. Publicly available quality measurement information is about 2 years out of date; dQMs allow providers to view patient outcomes and needed interventions in real time.

Health plans are implementing “gold carding,” which lessens or removes some administrative work related to prior authorization. Eligibility for gold carding can depend on a provider’s quality ratings, which incentivizes high-quality care. According to an AHIP 2022 survey, 58% of plans use gold carding for medical services—a more than 80% increase from 2019. dQMs can help providers qualify for gold carding with plans.

Most quality measures are based on claims and administrative data that are used for billing, limiting the ability to measure many aspects of health care quality. Replacing the current manual approach to quality measurement with digital quality measures (dQM) can increase the precision of measurement and the relevance of quality reports for clinicians seeking to improve care. They can also increase the validity of reported results and reduce the burden and costs associated with manual data collection and management.

Yes. After initially announcing that all quality measures would be converted to digital by 2025, CMS has moved this date to 2030. CMS recognizes that transitioning to dQMs will produce better insights about the health of populations and will increase the timeliness and relevance of information available to a “learning health system.” Together with ONC, CMS continues the push to standardize and harmonize health data through USCDI and USCDI+. With these data categories, FHIR (a uniform health data language) and APIs—the backbone of today’s internet economy—lay the groundwork for efficient exchange of health data.

The Universal Foundation and dQMs are part of an overall strategy to reduce burden and maximize the power of digital measures to improve patient outcomes. The Universal Foundation establishes a high-priority, standardized set of quality measures to promote alignment across CMS’s payment and quality programs, and focus the nation’s health system on key areas for improvement. Universal Foundation measures also emphasize building a modern health data exchange infrastructure to deliver the highest-quality care to patients—wherever they receive care.

dQMs pull data from certified health technology, which adheres to patient privacy and protections mandated in the 21st Century Cure Act. Additionally, health information will reside with HIPAA covered entities that safeguard the information and comply with federal and state regulations and standards for handling PHI.