Monday September 16th 2019

Recognizing quality care

Lisa Summers

Two notable reports on safety and quality from the Institute of Medicine — “To Err Is Human” and “Crossing the Quality Chasm” — have made a substantial impact on health care over the past two decades. And while health system reform continues to be debated, there is general agreement that patients, providers and payers will benefit with a shift toward paying for quality.

The challenge is defining high-impact quality measures, choosing the right mix of measures to monitor and, for the American Nurses Association, ensuring that nursing care — including care provided by advanced practice registered nurses — is appropriately recognized and measured.

In the quality arena, ANA has long had a strong presence, advocating for quality measurement, research, measure development and measures that underscore the value of nursing care through development of the National Database of Nursing Quality Indicators®.  In recent years, ANA’s efforts have focused on translating traditional quality measurements into eMeasures, and ensuring that nursing is at the table as quality measures are developed, endorsed and applied.

Quality incentives

The alphabet soup of health care becomes particularly thick when considering the National Quality Strategy and quality agenda, as well as the many organizations engaged in the process. For the past several years, ANA has monitored quality bonuses earned under the Physician Quality Reporting System (PQRS) implemented in 2007. Despite the name, APRNs are included as “eligible professionals,” and those who bill Medicare with a National Provider Identifier (NPI) earn awards under this system. The number of APRNs earning those awards has steadily risen (see details in One Strong Voice blog posts at and total reimbursement has reached $26 million. ANA’s health care economist Peter McMenamin notes it is incumbent upon the Centers for Medicare and Medicaid Services to maintain an incentive system that continues to reward APRNs who provide quality care to Medicare beneficiaries.

Source: Centers for Medicare and Medicaid Services

Changes ahead

The passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will eliminate the PQRS, replacing it with the Merit-based Incentive Payment System (MIPS). ANA has responded to requests for information from CMS, urging that MACRA implementation should ensure robust patient access to APRN services, and APRNs should be an integral part of its planning and implementation. Visit ANA’s regulatory web pages for details.

ANA is an active member of the National Quality Forum, a not-for-profit organization that convenes groups from the public and private sector to consider endorsement of consensus standards for performance measurement and prioritization of measures for CMS accountability programs. ANA provides an important voice for APRNs through NQF’s Measure Applications Partnership (MAP), which makes pre-rulemaking recommendations annually to the U.S. Department of Health and Human Services. Clinicians, even those enthusiastically supportive of quality measurement, have been justifiably frustrated trying to understand and report on a growing number of quality measures (the most recent list from the MAP included 130 potential Medicare quality measures). CMS has responded to providers’ concerns and recently reached agreement with America’s Health Insurance Plans on the first set of core measures, intended to simplify quality reporting by promoting alignment across payers.

ANA appreciates its members who have responded to requests to participate “upstream” in measures development and prioritization.

— Lisa Summers is the senior policy fellow in Health Policy at ANA.


ANA Advises Federal Agencies — comments on MACRA


NQF article about Measure Applications Partnership Report

Core Measures

APRN Focus column, “Despite the name, Physician Compare is not for physicians only”

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