Achieving National Quality Measurement and Reporting

1. Achieving National Quality Measurement and Reporting Helen Burstin, MD, MPH Senior Vice President, Performance Measures National Quality Forum Policy Roundtable Academy Health 2007

2. NQF Mission • To improve the quality of American healthcare by setting national priorities and goals for performance improvement, • endorsing national consensus standards for measuring and publicly reporting on performance, and • promoting the attainment of national goals through education and outreach programs.

3. What is the NQF? The National Quality Forum is a private, non-profit voluntary consensus standards- setting organization.

4. National Technology and Transfer Advancement of Act of 1995 (NTTAA) • Defines the five key attributes of a “voluntary consensus standards-setting body” (i.e., openness, balance of interest, due process, consensus, and an appeals process) • Obligates federal government to adopt voluntary consensus standards (when the government is adopting standards) • Encourages federal government to participate in setting voluntary consensus standards

5. Quality Measurement & Reporting: Problems • No national goal setting process • Not enough measures; too many measures • Too much process, not enough outcomes • Numerous methodologic issues • Competency vs high performance measures

6. Where are we with quality measures? Measure Development NCQA National Committee On Quality Assurance PCPI Physician’s Consortium For Performance Improvement CMS, Other Efforts National Quality Forum Measure Endorsement AQA Measure Approval for Implementation

7. Health Care Leadership Activated • Quality Alliances: HQA, AQA, APQ, PQA… • AMA Physician Consortium for Performance Improvement • 30+ Specialty Societies • ANA National Database of Nursing Quality Indicators (NDNQI)

8. Cost of Care Measures Efficiency Measures Patient Experience With Care payroll Private Sector Measures CMS PVRP RVU’s M.O.C Accounts payable scheduling credentialing Accounts receivable Quality measures Quality Dashboard Courtesy of Kevin Weiss, MD

9. National Quality Measurement & Reporting Infrastructure • Critically need to: • Set priorities and goals • Develop and maintain measures • Endorse “Best in Class” measures • Data aggregation • Public reporting

10. Quality Measurement & Reporting: Issues • Linked process and outcome measures • Episodes of Care (e.g., efficiency, cost, and value) • Measurement gaps (e.g., patient engagement, care coordination, and self-management) • Methodologic issues (e.g., attribution, exclusions) • Mode of measurement (transition to EHRs?)

11. Quality Measurement & Reporting: Health IT • Need greater dialogue between the quality and the health IT communities. • Need to specify the EHR data elements needed to produce quality measures (focus on quality of data elements and workflow). • Need to consider how interoperable systems begin to get us towards high impact gap areas (e.g., transitions, coordination of care)

12. Quality Measurement & Reporting: Disparities • Measures of healthcare disparities are essentially quality measures. • Disparities in health should not be a marginal or special interest issue. • Need to determine which measures should be routinely examined for disparities.

13. 1000 people New Ecology of Medical Care 800 have symptoms 327 consider seeking medical care 217 visit a physician’s office (113 to PCP) 65 visit CAM provider 21 visit a hospital OPD 14 receive home health 13 visit an ED 8 in a hospital <1 in an academic health center NEJM 2000, Green et al

14. Quality Measurement & Reporting: Population Health • Need to consider how we begin to measure the health of a population (align with emerging measures of public health quality) • Need to increase linkages between healthcare and public health systems • Interconnected health IT systems should allow for tracking of quality by population

15. Questions/inquiries:hburstin@qualityforum.org