CMS identified 20 high-priority conditions accounting for over 95% of costs. What activity is emphasized for these conditions?

• A. Expand hospital capacity
• B. Review and synthesize evidence
• C. Develop new surgical procedures
• D. Reduce electronic health records adoption

Answer: (B)

This item centers on using evidence to guide policy and improvement for the costliest conditions. When CMS identifies 20 high-priority conditions that drive most costs, the focus is on reviewing and synthesizing the best available evidence about how to manage those conditions effectively. By pulling together what studies show about treatments, care pathways, and outcomes, CMS can develop guidelines, quality measures, and payment approaches that promote value and reduce waste.

Expanding hospital capacity isn’t about optimizing care based on current evidence for these conditions; it’s more about increasing supply. Developing new surgical procedures isn’t the immediate aim for policy emphasis on high-cost conditions, which is better addressed through applying proven approaches rather than introducing unproven ones. Reducing electronic health records adoption would hinder the data needed to measure quality and outcomes, which is contrary to how CMS uses evidence to drive improvements.

So, reviewing and synthesizing evidence provides the foundation to inform guidelines, performance measures, and payment reforms for these costly conditions.