AMIA Calls for Overhaul of Electronic Quality Measures for Value-based Payments

Monday, February 1, 2016

Longitudinal Trending and Specialty Societies Should Guide Development of CQMs in an Electronic Environment, Experts Say

(BETHESDA, MD) — In comments submitted to the Centers for Medicare & Medicaid Services (CMS), the nation’s leading healthcare informaticians and data scientists urged federal officials to seize the “rare opportunity to reimagine” quality measurement, citing the continued proliferation of electronic health records (EHRs) and new policymaking authorities stemming from the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 (PL 114-10). Officials from the American Medical Informatics Association (AMIA) said CMS should rely on specialty societies to prioritize important measures for their particular patient populations, and build year-over-year consistency in what is measured so longitudinal measurement is possible.

In response to a CMS Request for Information (RFI) on certification frequency and requirements for the reporting of clinical quality measures (CQMs), AMIA said federal officials must look beyond programmatic policy levers to improve quality measurement.  Rather than focus on certification enhancements to CQMs, AMIA suggested a more fundamental overhaul is needed.

“Unfortunately, what ails quality measurement in healthcare will not be fixed by programmatic tweaks to existing processes for certification,” said AMIA President and CEO Douglas B. Fridsma, MD, PhD. “We need a better process that constructs measures based on the capabilities of EHRs and other health IT, includes pilot testing to ensure those measures can be implemented, and strives for simple measures that leverage high-quality electronic data. We need to understand the costs of data collection in addition to the benefits to patients. In a digital world, we need to reimagine quality measures based on digital evidence and digital data.”

AMIA recommended CMS lean on specialty societies to prioritize measures for use within MACRA-related policies, and they should help develop CQMs for use in an electronic environment.

“CMS has indicated in recent policies it is considering ways to impart key responsibilities to specialty societies in helping to develop MACRA-related policies, including in determining what evidence-based quality measures are important to track for their patient populations,” the group said in its comments. “AMIA supports the direction of this kind of policymaking, as specialty societies are well positioned to help define quality measures, clinical practice improvement efforts and can be important resources for federal regulators. CMS can play an important role to ensure that specialty societies use a consistent set of data standards and formats in their quality measures. This will simplify how EHRs collect quality measurement data for different specialty society measures.”

AMIA also pressed regulators to think more critically about longitudinal measures and attribution, because the quality of care models introduced through MACRA will be best measured as trends, rather than thresholds.

“Healthcare stands as one of the most measured industries in the US,” said AMIA Board Chair and Medical Director of IT Services at the University of Washington’s UW Medicine, Thomas H. Payne. “Yet, for all its measures, we understand very little about how patients fare as they travel through our healthcare system or how clinicians perform over time.  Now is the time to leverage our national investment in health IT to better define quality on a longitudinal scale.”

Click here to read AMIA’s full comments to the CMS RFI regarding quality measure certification and reporting requirements.


AMIA, the leading professional association for informatics professionals, is the center of action for 5,000 informatics professionals from more than 65 countries. As the voice of the nation’s top biomedical and health informatics professionals, AMIA and its members play a leading role in assessing the effect of health innovations on health policy, and advancing the field of informatics. AMIA actively supports five domains in informatics: translational bioinformatics, clinical research informatics, clinical informatics, consumer health informatics, and public health informatics.