Personal Blog #29 … Medicare Quality Measures, Part I … 11/4/22

 A doctor who read my June article, “Alzheimer’s Disease Support Groups,” suggested that if a support group referral could be declared a “quality measure” by Medicare, perhaps more doctors would discuss the importance of AD support groups and where their AD patients and caregivers could find them. 

I decided to follow up to learn more about Medicare “quality measures” and, specifically, to find out if more doctors might refer AD patients and caregivers to AD support groups if such referrals were considered “quality measures.”

My interaction with the Medicare bureaucracy began with a Google search.  I Googled the question, “Who is in charge of Medicare?” hoping to learn who I could email to find out more about quality measures.  The main Medicare website, cms.gov, states that “The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs the Medicare Program.  CMS is a branch of the Department of Health & Human Services (HHS).”  However, that site did not provide me with any email addresses.

I next Googled, “Who is the administrator in charge of Medicare?”  The first item that popped up was the name (and picture) of the person in charge and I read her biography on that site.  Chiquita Brooks-LaSure is the “Administrator for the Centers for Medicare and Medicaid Services (CMS).”  The site noted that LaSure has oversight responsibilities for many programs, including “Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the HealthCare.gov health insurance marketplace.”

Very helpful information, but I could not find an email address for LaSure at that or any other CMS site.  However, the cms.gov site, did provide brief biographies for the other three top Medicare administrators … the Principal Deputy Administrator & Chief Operating Officer, the Chief of Staff, and the Deputy Chief Operating Officer.  Only the Deputy Chief Operating Officer provided an email address, so I sent an email to Karen Jackson, Deputy Chief Operating Officer.  According to information on the cms.gov site, Jackson “provides executive leadership for CMS’s mission support functions …”

After a month passed and I still had received no response to my email, I searched to find another email address for someone who could answer my question, but found none.  Eventually, I ended up in an “online chat” with a helpful person, Brittany, at cms.gov.  Brittany placed me on hold several times to search for an email address, but she was unable to provide me with any email address for a top administrator other than for Jackson.  I told Brittany that surely there must be SOMEONE in the entire Medicare bureaucracy responsible for replying to emails from the public, but she was unable to find anyone else.

At that point, however, Brittany provided me with a helpful lead by referring me to another CMS agency, the “Quality Improvement Organization (QIO) Program.”  When I went to the QIO program page on the cms.gov site, I found this information: “The QIO Program, one of the largest federal programs dedicated to improving health quality for Medicare beneficiaries, is an integral part of the U.S. Department of Health and Human (HHS) Services' National Quality Strategy for providing better care and better health at lower cost. By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.”

I sent off an email to that QIO email address that basically restated my email to Karen Jackson a month earlier:

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I am hoping that you can help me. I am a former Alzheimer's disease (AD) spouse caregiver and I write frequently for publication about AD issues to help raise awareness and to help other caregivers. In one of my recent articles, I wrote about a problem that existed a dozen years ago and continues to exist today ... too many doctors do not alert AD patients and caregivers to the availability and helpfulness of local support groups.

A doctor who read my article said that if an AD support group referral were to be considered a Medicare "quality measure," perhaps more doctors would inform their patients and caregivers about how helpful support groups can be.  Based upon that doctor's comment, I have 2 questions:

 1. Is there a billing or reimbursement advantage for doctors who report using Medicare quality measures?

2. Is there any other advantage to doctors who use Medicare quality measures?  If a support group referral could become a "quality measure" that might lead to more AD patients and/or their caregivers seeking out such groups, what steps can I take to have Medicare consider such referrals as "quality measures."

 Thank you for your time and consideration.

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Hopefully there will be a Part II to this blog with a response from someone at QIO about Medicare quality measures, and if AD support groups discussions/referrals could become quality measures.  It is truly a shame that so many people with AD and their caregivers are unaware of the existence of support groups and how helpful such groups can be on their AD journey.  Whereas there are many more support groups today than there were back in 2009 when I first sought such groups, doctors today are still not routinely referring their AD patients and caregivers to support groups.  Maybe, just maybe, that doctor who commented to me about my article was right … maybe, just maybe, more doctors would make their AD patients and caregivers aware of such groups if doing so were considered a quality measure by Medicare.  Stay tuned!