CMS looks to expand equity measurement: Here’s what you need to know

Over the last two years, the Biden Administration has taken unprecedented steps to acknowledge systemic racism and advance equity for all. This has included several efforts specifically focused on healthcare. Following a Biden executive order that directed federal agencies to assess and advance equity, the Centers for Medicare and Medicaid Services (CMS) released their Framework for Health Equity 2022-2032, as well as the CMS Strategic Plan, which highlighted equity as the first of six key pillars in their agenda.

As part of this year’s rulemaking cycle, we’ve seen CMS take substantial steps to begin measuring equity within its quality reporting and value-based programs.

Inpatient 

CMS recently finalized three new equity-related measures within the Hospital Inpatient Quality Reporting Program for the CY 2023 reporting period. The first measure—Hospital Commitment to Health Equity—assesses a hospital’s commitment to health equity by attesting to activities within five domains related to strategic planning, data collection, data analysis, quality improvement, and leadership engagement. The second and third measures—Screening for Social Drivers of Health and Screen Positive Rate for Social Drivers of Health—assess the screening and positive identification of adults with five core health-related social needs (HRSNs): food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety.

CMS also finalized a new hospital designation related to maternity care, awarded to hospitals based on their attestation on the Maternal Morbidity structural measure within the Hospital Inpatient Quality Reporting Program. Hospitals that report that they are currently participating in a state or national perinatal QI collaborative and are implementing patient safety practices or bundles as part of these QI initiatives will receive the designation. The “birthing-friendly” designation will be available on a public-facing website (potentially Care Compare) beginning in fall 2023.

Beyond the inpatient setting

CMS has requested comments from stakeholders in nearly every major payment rule regarding the best ways to advance health equity measurement within their quality reported and value-based programs across the continuum. For example, for both the home health and hospice settings, CMS sought comments on topics like how agencies employ and recruit from diverse populations, how agencies identify barriers to care, and what barriers exist to collecting data related to disparities and SDOH. CMS noted that they are considering the potential future adoption of a structural composite measure for both the Home Health and Hospice Quality Reporting Programs where the agency would report on activities to address underserved populations’ access to home health/hospice care, the role of equity as a key organizational priority, how agency leaders and other staff are trained on culturally and linguistically appropriate services (CLAS) and implicit bias, and activities related to organizational inclusion initiatives.  Specific to the Expanded Home Health Value-Based Purchasing Model, CMS sought comments on whether they should consider incorporating adjustments into the Model to reflect the varied patient populations that home health agencies serve and tie health equity outcomes to payments made to home health agencies based on their performance in the Model.

Accountable care organizations and groups participating in the Merit-Based Incentive Payment System (MIPS)

Accountable care organizations and groups participating in the Merit-Based Incentive Payment System (MIPS) Program may soon have health equity requirements, too. CMS recently proposed to: 

• Create a health equity adjustment designed to support ACOs serving a high proportion of underserved individuals 
• Add four new Improvement health equity-related activities to the MIPS Program 
• Expand the definition of “high priority measure” within the Quality category of the MIPS Program to include health equity measures 
• Add one new Quality measure related to equity: Screening for Social Drivers of Health 

CMS also sought comments on adding a question about health disparities to the MIPS Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and how to incorporate health equity into public reporting on Care Compare. Additionally, CMS is beginning to include health equity requirements within the models coming out of the CMS Innovation Center, like the ACO Realizing Equity, Access, and Community Health (REACH) and Enhanced Oncology Models.

Health plans  

The Department of Health and Human Services (HHS) has taken actions related to equity that impact health plans. Most recently, HHS proposed to restore a 2016 rule on Section 1557 of the Affordable Care Act. Specifically, Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. A 2020 version of the rule limited its scope to cover fewer programs and services. Now, HHS is affirming these protections, reiterating protections from discrimination in reproductive healthcare, and requiring health plans to further develop their networks to prevent discrimination, create anti-discrimination policies, and train staff on those policies. While much of the proposal would reestablish elements of the 2016 rule, new proposals include a prohibition on discrimination in the use of clinical algorithms and the creation of a clear process for raising conscience and religious freedom objections.

Outside of that proposed rule, CMS is broadly seeking comments about how to strengthen the Medicare Advantage program in ways that align with CMS’s Strategic Plan and pillars, including health equity.

Going forward 

The information outlined here does not include all the health equity-related proposals, changes, or requests for comments that CMS has made so far this year. In fact, CMS was clear to note that these new measures and other proposals are essentially baby steps in their ongoing efforts to better understand, measure, and advance health equity. Looking ahead, we expect CMS to expand measurement to all quality reporting and value-based programs, including the potential to adjust payments to providers, facilities, and health plans based on health outcomes of all groups as opposed to the entire patient population, as well as publicly report equity-related measure performance.

We encourage all our clients to get a head start on these efforts and join the Equity Partnership, ensuring you receive news like this, webinars, equity-focused resources, and the equity data diagnostic. If you’re a current Press Ganey client, we recommend working with your Press Ganey team to segment your patient experience and workforce data to maximize insights related to diversity, equity, and inclusion.