For the first time ever, public and private payers have an agreed upon core set of quality measures from which to work from for quality improvement, clinical decision-making, and value-based payment and purchasing purposes. The Core Quality Measures Collaborative, of which the ACC is a part, today announced six core quality measure sets, including one for cardiology.

In a statement, the Collaborative, convened by the Centers for Medicare and Medicaid Services and America’s Health Insurance Plans, noted that the evidence-based measures will make “quality measurement more useful and meaningful for consumers, employers, clinicians and public and private payers,” while also serving as a model “for future work on performance measurement alignment in these and other areas.” The other five measure sets involve Accountable Care Organizations (ACO)/Patient Centered Medical Homes (PCMH)/Primary Care, Gastroenterology, HIV/Hepatitis C, Medical Oncology, Obstetrics and Gynecology, and Orthopedics.

“This is an exciting day for quality improvement,” said Richard A. Chazal, MD, FACC, ACC president-elect. “The ACC has long been advocating on behalf of its members and their patients for alignment of quality measures among health plans and the Centers for Medicare and Medicaid Services. Today’s announcement is testament to these efforts and will undoubtedly help move us forward as we continue to transition to a health care system focused on ensuring quality and value.”

The ACC has been involved in the Collaborative since 2014 and played an instrumental role in advocating for the addition of 10 measures developed by the ACC with other stakeholders, including the American Heart Association (AHA). For example, antiplatelet therapy for patients with stable coronary artery disease and chronic anticoagulation therapy for patients with atrial fibrillation at high-risk for thromboembolism. Additionally, the College successfully advocated for the removal of six claims-based measures that were supported by payers.

Both the ACC and the AHA (which joined the collaborative in September 2015 with other patient groups), however, are concerned about the inclusion of two conflicting measures addressing blood pressure control for patients with hypertension given their potential to confuse patients and providers. One measure (NQF #0018), defines adequate control as less than 140/90 mmHg, while the second measure (HEDIS 2016) relaxes the target for adequate control to less than 150/90 mmHg for patients aged 60 and older without diabetes mellitus or chronic kidney disease. The HEDIS measure is based on controversial recommendations published by a former National Heart, Lung, and Blood Institute panel, but is not based on a formally recognized guideline. The ACC and AHA are currently in the process of developing a hypertension guideline that evaluates the full span of the evidence, including the endpoint of stroke. The Core Quality Measures Collaborative has pledged to revisit and potentially revise the hypertension recommendation when the new guideline is published.

“Since we believe there is a need for clarity on the best blood pressure goals for different groups of people, we are pleased that the Collaborative acknowledges the obligation to update the measures on blood pressure management, as recent research is reviewed and new guidelines written,” said Mark Creager, MD, FACC, FAHA, AHA president.

“Both the ACC and AHA strongly urge all health care providers and patients to strive to reach a blood pressure target of less than 140/90 mmHg,” says Chazal. “To do otherwise may put patients’ lives and well-being at risk. We also urge all patients to talk to their doctors about their own risk for cardiovascular disease and stroke and to learn what steps they can take to reduce it.”

Moving forward the organizations will work together and with members on how best to implement and continue to evaluate the core set of cardiovascular measures, eight of which are already part of ACC’s PINNACLE Registry reporting.  Additionally, the College will be working with members and payers where feasible to include ACC/AHA measures in payer contracts.

“Reaching a consensus among the collaborative participants on a core set of cardiovascular quality measures should be seen as an important milestone,” said Paul N. Casale, MD, MPH, FACC, who represented the ACC in the Collaborative. “Our work is not done and we will be working to update and refine this core set of quality measures as we move forward and new evidence emerges and performance measures are developed or updated to align with the evidence. We will also be working with the AHA to ensure that implementation of the core cardiovascular measure set will be evaluated for unintended consequences like patient harm.”

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