The Quality Payment Program (QPP), established by MACRA in 2015, requires physicians to report quality measures that influence Medicare reimbursements. Over time, some measures become "topped out" and no longer differentiate performance, leaving gaps in available reporting options. This study evaluates the number of quality measures available for reporting from 2017 to 2022 across all specialties to identify trends and gaps in reporting options.
We conducted a longitudinal analysis of the quality measures available for reporting within each specialty from 2017 to 2022. The primary outcome was the number of reporting options per specialty each year. Secondary outcomes included the average time for quality measures to top out, the availability of a qualified clinical data registry (QCDR) for each specialty, and the distribution of process, structure, and outcome measures across all specialties. Data was collected from Center for Medicare and Medicaid Services (CMS) public use files.
Radiology had the most reporting options, rising from 125 measures in 2017 to 130 in 2022. Internal medicine remained stable with 110–115 measures throughout 2017-2022. Plastic surgery saw the steepest decline, dropping from 35 to 12 measures by 2022. Pathology and orthopedic surgery fluctuated, with pathology peaking at 65 measures in 2019 and falling to 40 by 2022. Overall, 62% of specialties had QCDR access on average in a given reporting year. Process measures comprised 68%, structure measures 12%, and outcome measures 20%.
The reduction in reporting options in the last six years, especially in plastic surgery, limits CMS’s ability to nationally stratify physician performance. The discontinuation of plastic surgery-specific QCDRs highlights the need for new quality measures in the field. CMS and quality measure developers must prioritize creating effective reporting options to ensure all specialties, particularly plastic surgery, can improve care quality and physician performance evaluation.
Quality Measures. Center for Medicare and Medicaid Services. Accessed August 9, 2024. https://www.cms.gov/medicare/quality/measures
Lazar EJ, Fleischut P, Regan BK. Quality measurement in healthcare. Annu Rev Med. 2013;64:485-96. doi:10.1146/annurev-med-061511-135544
2024 MIPS Annual Call for Quality Measures Fact Sheet. Centers for Medicare and Medicaid Services. Accessed July 29, 2024. https://mmshub.cms.gov/sites/default/files/2024-MIPS-Annual-Call-for-Quality-Measures-Fact-Sheet.pdf
Calendar Year (CY) 2024 Medicare Physician Fee Schedule (PFS) Final Rule Fact Sheet and Policy Comparison Table. Center for Medicare and Medicaid Services. Accessed August 9, 2024. https://www.cms.gov/files/document/2024qpppoliciesfinalrulefactsheet.pdf
Golding LP, Nicola GN, Duszak R, Jr., Rosenkrantz AB. The Quality Measure Crunch: How CMS Topped Out Scoring and Removal Policies Disproportionately Disadvantage Radiologists. Journal of the American College of Radiology. 2020;17(1):110-117. doi:10.1016/j.jacr.2019.08.014
Landrum MB, Nguyen C, O’Rourke E, Jung M, Amin T, Chernew M. Measurement Systems: A Framework for Next Generation Measurement of Quality in Healthcare. Accessed August 10, 2024. https://www.qualityforum.org/Story/Measurement_Systems_White_Paper.aspx