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Why do we need quality measures in emergency medicine?

Shamie Das1, Gregg Miller2, Christopher Libby3

  • 1Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA.

Journal of the American College of Emergency Physicians Open
|December 19, 2024
PubMed
Summary

Emergency physicians must understand quality measures impacting reimbursement. This whitepaper guides them through Centers for Medicare and Medicaid Services (CMS) programs and the importance of performance in emergency care payment.

Keywords:
CMSemergency medicinepayment reformquality measuresreimbursementvalue‐based care

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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.