Quality Metrics

CMS is pushing quality measurement deeper into mandatory and specialty-focused payment models, but stakeholders are pressing for more implementation runway: hospital and provider groups are urging delay of the Ambulatory Specialty Model over unresolved operational, technical, and reporting issues, even as evidence from CJR’s $180M in savings strengthens the case for broader episode-based payment expansion (CJR savings and expansion signal; ASM delay request). At the same time, Medicare Advantage star ratings litigation—including CVS/Aetna’s claimed $2B impact—shows that quality metrics are now material financial assets, while ACO stakeholders are positioning FHIR-enabled reporting as a path to reduce burden and make quality performance more real-time and operationally actionable.