National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Reports
The National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Reports (Impact Assessment Reports) are required by section 1890A(a)(6) of the Social Security Act, which provides that the Secretary shall, not later than March 1, 2012, and at least once every three years thereafter, conduct an assessment of the quality and efficiency impact of the use of endorsed measures described in section 1870(b)(7)(B) of the Social Security Act and make such assessment available to the public. In keeping with the commitment to put patients first, CMS uses quality measures to support a patient-centered health care system anchored by quality, accessibility, affordability, innovation, and responsiveness.
CMS used multiple analyses of measure performance trends, disparities, patient impact, and costs avoided, as well as national surveys in hospital and nursing home quality leaders, to evaluate the national impact of the use of quality measures. Key Indicators were selected from CMS measures with input from a Technical Expert Panel and a Federal Assessment Steering Committee to assess national performance regarding the CMS quality priorities of patient safety, person and family engagement, care coordination, effective treatment, healthy living, and affordable care. Highlights include these main findings:
- Patient impacts estimated from improved national measure rates indicated approximately:
- 670,000 additional patients with controlled blood pressure (2006–2015).
- 510,000 fewer patients with poor diabetes control (2006–2015).
- 12,000 fewer deaths following hospitalization for a heart attack (2008–2015).
- 70,000 fewer unplanned readmissions (2011–2015).
- 840,000 fewer pressure ulcers among nursing home residents (2011–2015).
- 9 million more patients reporting a highly favorable experience with their hospital (2008–2015).
- Costs avoided were estimated for a subset of Key Indicators, data permitting. The highest were associated with increased medication adherence ($4.2 billion–$26.9 billion), reduced pressure ulcers ($2.8 billion–$20.0 billion), and fewer patients with poor control of diabetes ($6.5 billion–$10.4 billion).
- National performance trends are improving for 60% of the measures analyzed, including a majority of outcome measures, and are stable for about 31%.
- Overwhelmingly, hospitals (92%) and nursing homes (91%) surveyed reported they consider CMS measures clinically important. Likewise, 90% of hospitals and 83% of nursing homes agreed that performance on CMS quality measures reflects improvements in care. Respondents also described barriers to reporting, including burden; barriers to improving performance; and unintended consequences of CMS measures.
- Disparities by race/ethnicity, income, sex, rural versus urban, and region were identified. The highest percentages of measures with disparities were observed for the following groups: Black (41%), Native Hawaiian/Pacific Islander (46%), Hispanic (37%), low income (42%), noncore or rural (23%), and West North Central region (26%).
The 2018 National Impact Assessment Report and associated appendices can be accessed via the link in the Downloads section below.
The 2015 Impact Report encompasses 25 CMS programs and nearly 700 quality measures from 2006 to 2013 and employs nine key research questions. A Technical Expert Panel of quality measurement leaders from across the health care industry and a Federal Assessment Steering Committee consisting of stakeholders from CMS and other U.S. Department of Health and Human Services (HHS) agencies were convened to provide input into the report.
The 2015 National Impact Assessment Report and associated appendices can be accessed via the link in the Downloads section below.
For the March 2012 report, CMS assessed the impact of quality measures within two categories:
- Implemented measures with at least two years of performance information between 2006 and 2010.
- Measures under consideration by CMS and made available to the public in December 2011.
The 2012 Impact Report can be accessed via the link in the Downloads section below.
- 2018 Impact Assessment Report [PDF, 5MB]
- 2018 Impact Assessment Report Appendices [ZIP, 4MB]
- 2015 National Impact Assessment Report and Appendices [ZIP, 11MB]
- 2012 Impact Report [ZIP, 2MB]
- HHS Decision Rules for Categorizing Measures of Health, Health Care Quality, and Health Care Affordability [PDF, 524KB]
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