Why do we need quality measures in emergency medicine?

Abstract

Quality measures increasingly influence the delivery and reimbursement of care provided in emergency departments. While emergency physicians are accustomed to using quality measures to improve care delivery, payors, including the Centers for Medicare and Medicaid Services (CMS), are increasingly adjusting reimbursement to measure performance as a means to bend the cost curve and improve the value of healthcare services. The American College of Emergency Physicians Quality and Patient Safety Committee presents this whitepaper to guide practicing emergency physicians through the policy context of implementing measures in emergency care and understanding its impact reimbursement. This paper summarizes current CMS programs such as the merit-based incentive payment system (MIPS), MIPS value pathways, and alternative payment models and various reporting mechanisms. It is crucial for emergency physicians to understand the quality measure development process, the need for more emergency medicine-specific quality measures, and the growing significance of measure performance in the payment of emergency care.

Keywords: CMS; emergency medicine; payment reform; quality measures; reimbursement; value‐based care.

FIGURE 1

Examples of structure, process, and outcome quality measures in emergency medicine.

FIGURE 2

Measure development lifecycle (CMS. Blueprint measure lifecycle. Measures Management System. 2022. https://mmshub.cms.gov/blueprint‐measure‐lifecycle‐overview).

FIGURE 3

Overview of the Quality Payment Program (QPP). Most emergency physicians in group practice collectively report through the merit‐based incentive payment system (MIPS) utilizing a qualified clinical data registry (QCDR) or qualified registry (QR). Some physicians in large multispecialty practices, such as academic health centers will participate through alternative payment models (APMs) as accountable care organizations(ACOs). The MIPS value pathway (MVP) became available for submission in 2023 with possible payment adjustments as early as 2025.