Hidalgo County clinic helps shape Medicare quality measures

Hidalgo Medical Services has taken a seat at the national table that helps decide which quality measures the Centers for Medicare & Medicaid Services (CMS) uses to judge and pay for care. The Weslaco-based community health organization has been participating since 2024 in a consensus-based process that reviews, endorses, and maintains measures used by CMS — a process that can directly affect what services are prioritized and reimbursed across Hidalgo County.

Ethan Novikoff, MPH, director of quality and safety for Hidalgo Medical Services, was appointed in July 2024 to serve on two Partnership for Quality Measurement review committees on behalf of the clinic. Novikoff currently serves on a Pre-Rulemaking Measure Review committee, which focuses on reviewing measures under consideration and deciding whether to recommend a measure for use in a specific CMS program. That committee includes a diverse mix of patients, caregivers, patient advocates, and representatives of traditionally underrepresented groups.

Quality measures are standardized tools that track care processes, outcomes, and patient experiences. CMS uses those measures to shape payment models, public reporting, and clinical priorities. Changes to measures can alter which screenings, chronic care checks, or follow-up practices clinics are asked to report on and may influence where funding flows. For a borderland community like the Rio Grande Valley, having local perspectives in those conversations helps ensure measures reflect bilingual care, cross-border health patterns, and the needs of low-income and migrant populations.

Hidalgo Medical Services’ involvement means local clinicians and patients could help steer recommendations before they reach formal rulemaking. The pre-rulemaking phase is important because it sifts candidate measures for practicality, equity, and relevance to real-world clinics. For Hidalgo County residents, that could translate into measures that better capture local health priorities such as diabetes control, maternal health, preventive screenings, and access to culturally competent care.

The committee process is ongoing and consensus-based, so recommendations from Pre-Rulemaking could move into later rulemaking stages and ultimately be adopted by CMS programs that affect Medicare and Medicaid beneficiaries. For local providers, potential outcomes include new reporting requirements, shifts in quality improvement targets, and changes in reimbursement tied to performance on those measures.

HMS’s participation is a reminder that national policy is shaped by local voices. Residents and providers in Hidalgo County should watch for future updates from their clinics about changes to care protocols or reporting. In the months ahead, committee recommendations may influence which services are emphasized and how clinics across the valley document the quality of the care they provide.