Why do we need quality measures in emergency medicine?

Area of Science:

• Health Policy
• Healthcare Management
• Emergency Medicine

Background:

• Quality measures significantly impact emergency department (ED) care delivery and reimbursement.
• Payors, including the Centers for Medicare and Medicaid Services (CMS), are linking reimbursement to performance to control costs and enhance healthcare value.

Purpose of the Study:

• To guide emergency physicians in understanding the policy landscape of quality measures in emergency care.
• To explain the impact of quality measure performance on reimbursement.

Main Methods:

• This whitepaper summarizes current CMS programs relevant to emergency medicine.
• It outlines reporting mechanisms and payment models such as the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models.

Main Results:

• Emergency physicians need to grasp the quality measure development process.
• There is a recognized need for more emergency medicine-specific quality measures.
• Measure performance is increasingly critical for emergency care reimbursement.

Conclusions:

• Understanding quality measures and CMS programs is essential for emergency physicians.
• Advocating for and developing relevant quality measures is crucial for the specialty.
• Physicians must adapt to the evolving payment structures driven by quality performance.