Many chronic conditions seen in long-term care settings are under-represented in Medicare pay-for-quality programs, an Avalere survey has found. This shortcoming limits the program’s ability to pay for value, investigators noted.
Among the top 20 high impact conditions listed in Avalere’s assessment, osteoporosis, hip/pelvic fracture, lung cancer and prostate cancer have only three Medicare quality measures, while Alzheimer’s and endometrial cancer have zero.
“Quality measures are increasingly driving the economics of Medicare Advantage and other coordinated care programs,” said Avalere CEO Dan Mendelson in the assessment. “As Medicare and other payers move towards value based payments for services and pharmaceuticals, we need more meaningful quality measures.
The Centers for Medicare & Medicaid programs evaluated as part of the assessment include hospice quality reporting, Medicare Advantage star ratings, Medicare and Medicaid electronic health record incentive programs, the Medicare shared savings program and the nursing home quality initiative.
