Aligning Performance Measurement A Public Sector-Private Sector Initiative

1. Aligning Performance MeasurementA Public Sector-Private Sector Initiative Paul M. Schyve, MD Senior Vice President Joint Commission on Accreditation of Healthcare Organizations

2. Joint Commission on Accreditation of Healthcare Organizations 2 Uses of Performance Measurement Improvement Accountability Choice

3. Joint Commission on Accreditation of Healthcare Organizations 3 Prerequisites to Use Improvement Relevant, reliable, valid (Comparative) Accountability Relevant, reliable, valid Comparative Choice Relevant, reliable, valid Comparative

4. Joint Commission on Accreditation of Healthcare Organizations 4 Costs of Measurement Duplication in measure development Not relevant, reliable, valid Duplication in collection/reporting �Duplication� with variation Competition among measures

5. Joint Commission on Accreditation of Healthcare Organizations 5 Advantages of Standardization Pool developmental costs Reduce duplication, competition Enable valid comparisons Satisfy multiple stakeholders

6. Joint Commission on Accreditation of Healthcare Organizations 6 Multiple Stakeholders Health care organizations � improvement Consumers � choice Purchasers � choice and accountability Regulators � accountability

7. Joint Commission on Accreditation of Healthcare Organizations 7 Efforts to Standardize Accreditors JCAHO ORYX core measures (AMI, HF, CAP, Pregnancy) NCQA HEDIS AMA/JCAHO/NCQA collaboration Diabetes, cardiovascular, perinatal care, pain management CMS QIO 7th Scope of Work JCAHO/CMS alignment States, Leapfrog, etc.

8. Joint Commission on Accreditation of Healthcare Organizations 8 Final Common Pathway - NQF 51% purchaser, consumer board Member councils on board Consumer Purchaser Provider Research and Quality Improvement CMS, AHRQ on board Solicit measures � steering committee Member review and vote Board adoption

9. Joint Commission on Accreditation of Healthcare Organizations 9 National Quality Forum ORYX/ 7th Scope of Work hospital measures Adult diabetes care Serious reportable events Safe practices Framework for health care quality measurement and reporting

10. Joint Commission on Accreditation of Healthcare Organizations 10 From Standardization to Implementation JCAHO ORYX Core data collection began July 1, 2002 Transmit to JCAHO January 31, 2003 QIO 7th Scope of Work � same foci Public-private voluntary reporting initiative

11. Joint Commission on Accreditation of Healthcare Organizations 11 The Public-Private  Reporting Initiative Initiated by AHA Participants AHA, FAH, AAMC JCAHO, AHRQ, HHS/CMS NQF Supporters: AARP, AFL-CIO

12. Joint Commission on Accreditation of Healthcare Organizations 12 Goals of Initiative Provide public with information on hospital quality Meaningful, relevant Easily accessible Foster quality improvement Replace duplicative hospital reporting requirements Standardize data collection priorities Provide hospitals with sense of predictability

13. Joint Commission on Accreditation of Healthcare Organizations 13 Reporting Initiative 10 NQF measures (from CMS/JCAHO) State pilots: MD, NY, AZ CMS/QIO in each state Technical assistance in QI QIO JCAHO Study use by consumers

14. Joint Commission on Accreditation of Healthcare Organizations 14 Initiative Measures - I Acute MI Aspirin at admission Aspirin at discharge Beta blocker at admission Beta blocker at discharge ACE inhibitor for patient with heart failure Heart failure Assessment of heart function ACE inhibitor given

15. Joint Commission on Accreditation of Healthcare Organizations 15 Initiative Measures - II Pneumonia Antibiotic timely Pneumococcal vaccination Oxygen level assessed at admission

16. Joint Commission on Accreditation of Healthcare Organizations 16 More Light at End of Tunnel Priorities for measurement IOM report AHRQ National Quality Report