What is Quality Improvement CME?

Some have proposed defining it as the combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make changes that will lead to better patient outcomes (health), better system performance (care) and better professional development. This definition arises from a conviction that healthcare will not realise its full potential unless change making becomes an intrinsic part of everyone's job, every day, in all parts of the system. Source.

Why is this important to CME specifically?

Clearly, improving outcomes is important. But on a very practical level for an individual physician, Medicare will reward physicians who complete 'quality improvement' CME as part of the Merit Based Incentive Payment System (MIPS). MIPS was created as part of the Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Per the ACCME, "accredited CME providers can support their clinician learners in several ways: you can help clinicians understand how to identify Improvement Activities, facilitate those activities, and then assist clinicians in attesting to their participation; and you can plan and present CME activities that will count as Improvement Activities." The ACCME has a webinar that explains how CME can qualify for MIPS.

In addition, the American College of Physicians has a program designed to coach organizations and physicians in improved patient care called ACP Advance.  This program, launched in 2019 "will provide subscribed individuals and organizations with a 12-month tailored coaching program that includes a curriculum and access to online training courses and resources."

Another valuable resource is the repository of case studies where you can "Learn from other hospitals about successful strategies to create safe, reliable health care processes and deliver high-quality care to patients."

To meet the criteria for Improvement Activities in the Merit-Based Incentive Payment System (MIPS) of QPP, accredited CME providers need to implement activities that:
- Address a quality or safety gap that is supported by a needs assessment or problem analysis, or support the completion of such a needs assessment as part of the activity;
- Have specific, measurable aim(s) for improvement;
- Include interventions intended to result in improvement;
- Include data collection and analysis of performance data to assess the impact of the interventions; and
- Define meaningful clinician participation in their activity, describe the mechanism for identifying clinicians who meet the requirements, and provide participant completion information.

Additional resources that may prove useful:

• The National Committee for Quality Assurance's FAQ.
• The ACCME's MIPS FAQ.
• 10 FAQs About the Merit-based Incentive Payment System (MIPS)
• CMS MACRA Guide and FAQ.

MACRA Funding Announcement [Excerpt]

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program

Cooperative agreement awardees
On September 21, 2018, we selected 7 applicants to receive cooperative agreement awards through the “Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program.”
The cooperative agreements give financial and limited technical support to:
    Develop
    Improve
    Update or
    Expand measures to use in the Quality Payment Program.
Measures for consideration include:
    Outcome measures such as patient-reported outcome and functional status measures.
    Patient experience measures.
    Care coordination measures.
    Measures of appropriate use of services.
We’re committed to advancing quality measures that:
    Minimize burden on clinicians.
    Improve outcomes for patients.
    Drive value in care.
It's critical that we leverage the expertise and insight of those on the front lines to develop measures that make the most sense and contribute to building a truly value-based healthcare system. We look forward to partnering with these organizations.

95% of eligible clinicians participated in the first year of the Merit-based Incentive Payment System!

[Excerpt] MIPS participation in year 1 nets 95% of eligible clinicians

In terms of quality measures selected and reported, the most prevalent was controlling high blood pressure, an intermediate outcome measure, according to the report. The rest of those in the top 10 were process measures. Among them were tobacco screening and intervention, breast cancer screening and pneumococcal vaccine status in the elderly.

The most reported improvement activity was providing 24/7 access to a patient's medical record, a key ingredient in ensuring timely and coordinated care. Rounding out the top five were use of decision support and standardized treatment protocols, patient-centered medical home attestation, engagement of patients through implementation of improvements in a patient portal, and collection and follow-up on patient experience and satisfaction data on beneficiary engagement. [Source]