Clinical quality measures based on claims are commonly used to determine clinician and health care facility may contribute to performance as part of a value-based payment system. A new approach uses electronic clinical quality measures (eCQMs) that are generated from electronic health records (EHRs). eCQMs may provide a more complete picture of care than claims-based measures. This study created eCQM performance benchmarks for determining whether primary care practices in the Comprehensive Primary Care (CPC) initiative should receive a shared- savings, value-based payment. CPC is a patient centered medical home model sponsored by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS).
No other Medicare program has used EHR reported eCQM performance data in value- based payment to date. The results of this study raise important implications for alternative payment models. Study Design: We began by considering CMS Physician Quality Reporting System (PQRS) group reporting data quality and reliability. We determined data quality by analyzing the percentage of records with missing values, invalid values, missing or invalid performance rates, and high exclusion or exception rates. We estimated reliability values for all reporting groups, which were then aggregated to estimate overall reliability for each measure. We calculated benchmarks at the 25th, 50th, and 75thpercentiles of the distribution of each measure.
Calendar year 2015 was the first in which eCQM performance factored into a shared savings payment for practices participating in CPC. To be eligible for shared savings, practices were required to meet performance benchmarks for 9 of 11 possible eCQMs. To construct these benchmarks, we used eCQM performance data from group practices that reported electronically to the CMS PQRS.