Multi-Stakeholder Group Weighs-in on Quality Measures for Use in Federal Healthcare Programs

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The Measure Applications Partnership has submitted its first annual review of performance measures being considered this year for use in federal rulemaking.

At the request of the Department of Health and Human Services (HHS), the Measure Applications Partnership (MAP) has submitted its first annual review of performance measures being considered this year for use in federal rulemaking.

The measures evaluated by MAP will be used in public reporting and performance-based payment programs that help drive system-wide quality improvement and accountability. The measures apply to nearly 20 different federal healthcare programs. These include the existing Medicare Physician Quality Reporting System, Hospital Inpatient Quality Reporting, and Electronic Health Record Incentive Programs (Meaningful Use for clinicians and hospitals), as well as the new Hospital Value-Based Purchasing and Medicare Shared Savings Program (Accountable Care Organizations).

MAP is a multi-stakeholder, consensus-based group of 60 organizations representing the full range of private- and public-sector healthcare stakeholders. These include employers, consumers, labor, clinicians, health plans, hospitals and other health care facilities. MAP also includes 40 subject matter experts and representatives from nine federal agencies. The group was convened by the National Quality Forum (NQF) (http://www.qualityforum.org) and began its deliberations in spring 2011.

MAP represents the first time the federal government has looked to a public-private collaboration in advance of healthcare rulemaking, to advise on which quality measures should be used in federal healthcare programs. Congress recognized that achieving quality and performance measurement that is aligned across federal, state, and private-sector programs would require a public-private partnership.

HHS sought broad input on a list of more than 350 measures and potential measures (a measure idea not yet fully specified or tested) the department put forth in December 2011. In past years HHS has issued rules on performance measurement one healthcare program or initiative at a time. As a result, measures in different programs vary widely. HHS recognized that providers and the public would benefit from a process that deliberately encourages a cross-program and coordinated look at the measures it selects for use in public programs.

“We need to make this complex effort work better so patients benefit the most,” said George Isham, MD, MS, co-chair of the MAP Coordinating Committee. “The unique public-private nature of MAP ensures that HHS is informed upstream by diverse and thoughtful healthcare leaders who are invested in the outcomes of measurement.”    

Using measure selection criteria shaped over six months, MAP winnowed down the pool of more than 350 measures and potential measures to those it determined were best for adoption. MAP made one of three conclusions for each measure or potential measure:

  •     Support – MAP supported approximately 40 percent of the measures under consideration by HHS for 2012 rulemaking.    
  •     Support direction – MAP supported the direction and aspiration of approximately 15 percent of the measures under consideration but indicated further development and testing is needed before inclusion in any federal program.
  •     Do not support – MAP recommended against adopting 45 percent of the measures under consideration and potential measures but the group emphasized that for nearly 70 percent of these it did not have enough information to complete a full evaluation at this time.

MAP prioritized for support measures that promote care coordination, team-based care, safe care, and evidence-based prevention and treatment practices that address the leading causes of mortality, starting with cardiovascular disease. Its work was guided in large part by the priorities established in the first-ever National Quality Strategy report released by HHS in March 2011.

MAP identified many important “measure gaps”– clinical or care delivery areas where measures either do not exist or have yet to be fully specified and tested.    Notable measure gaps were found in the following areas: patients’ experience-of-care and their functional status after treatment; shared decision-making between patients and doctors; mental health status; care coordination; cost and affordability of care; appropriateness of care; care in emergency rooms; and measures that help elucidate disparities in care between population groups. MAP encouraged HHS to fund measure development and testing in these areas.

“We found a number of promising and innovative measures and ideas that currently lack the specificity and testing necessary for adoption,” said Elizabeth McGlynn, PhD, co-chair of the MAP Coordinating Committee. “It’s our hope that MAP’s input will push these ideas to the next level for consideration in the future. If provided with proper funding, measure developers could use these concepts to help fill critical measurement gaps.”

In addition to its new pre-rulemaking report, MAP has presented to HHS measurement strategy reports on patient safety, clinician performance, and on the care provided to the 9 million people eligible for both Medicare and Medicaid (the dual eligible population). MAP is also releasing a report this month on performance measurement strategies for long-term care and post-acute care facilities and services. Future reports will address measurement strategies for hospice care and cancer hospitals.

“This new MAP report on the selection of measures, along with the performance measurement coordination strategies already submitted and currently in development, offers a pioneering approach to the way measures are selected by the federal government” said Janet Corrigan, PhD, MBA, president and CEO of NQF. “Taken together, they prove that public-private sector collaboration can lead us down a path toward achieving the aims of the National Quality Strategy - healthier people and communities, better care, and more affordable care.”

The full report is available online (http://tinyurl.com/6ogf5gq). Learn more about the work of the Measure Applications Partnership (http://tinyurl.com/4lklzg8).

The National Quality Forum operates under a three-part mission to improve the quality of American healthcare by:

  •     building consensus on national priorities and goals for performance improvement and working in partnership to achieve them;
  •     endorsing national consensus standards for measuring and publicly reporting on performance; and
  •     promoting the attainment of national goals through education and outreach programs.

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Erin Reese
The National Quality Forum
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