Christine Ritchie, MD MSPH FACP FAAHPM
This has been a historic year for healthcare quality. On January 26, US Secretary of Health and Human Services Sylvia Burwell stated that by 2016, 85% of all Medicare fee-for-service payments would be tied to quality or value and by 2018, 90% would. On June 25, in a 6-3 decision, the Supreme Court upheld the Affordable Care Act. A few days later, the Centers for Medicare & Medicaid Services (CMS) released the first proposed update to the physician payment schedule since the repeal of the Sustainable Growth Rate (SGR) through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; see feature). The proposal includes a number of provisions focused on person-centered care and continues the administration’s efforts to transform the Medicare program to a system based on quality and person-centered outcomes.
The move from fee-for-service reimbursement to “value-based care” is now embedded in virtually every aspect of funding to providers by CMS. The Merit-Based Incentive Payment System (MIPS) replaces the plethora of federal quality-reporting mandates with a consolidated program that holds physicians accountable for value. But who will define value for health care and, in particular, for hospice and palliative care? The field of hospice and palliative medicine needs reliable and valid quality metrics that accurately reflect the care we seek to provide in order to participate in MIPS: person-centered, preference-aligned care, concordance with patient and family goals, effective communication, symptom control, and care coordination, to name a few.