Performance Measurement Accelerating Improvement (2006) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-16
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-- organizations, professional associations, payers, regulators, accrediting bodies, and consumer groups have begun to make significant changes in their respective agendas and investments, all designed to achieve better safety, effectiveness, patientcenteredness, timeliness, efficiency, and equity -- the six aims for quality improvement specified in the Quality Chasm report. Initiatives undertaken include quality improvement collaboratives and other change programs; explorations of pay for performance; the development of early formats for public reporting on performance; and, most important, efforts to devise better ways to measure quality in nearly all of its dimensions.
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Performance measures can serve as the foundation for public reporting programs intended to promote accountability among providers and to aid consumers in making informed choices, serve as the basis for payment incentives that reward providers who deliver more effective and efficient care, and guide and inform clinicians and organizations in their quality improvement initiatives. This first report in the Pathways series focuses on the selection of measures to support the quality improvement efforts of a diverse set of stakeholders, and on the creation of a common infrastructure for guiding and managing a consistent set of such measures nationally and regionally.
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These efforts have yielded a laudable array of assets for performance measurement. However, the committee believes a well-functioning national system that can meet the need for performance measurement and reporting is unlikely to emerge from current voluntary, consensus-based efforts, which are often fragmented and lack a consistent connection to explicit, overarching national goals for health care improvement.
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IN GENERAL-Not later than the date that is 2 months after the date of the enactment of this Act, the Secretary shall enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences (in this section referred to as the `Institute') shall conduct an evaluation of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program under title XVIII of the Social Security Act (42 U.S.C.
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· Recommend a process for the ongoing promulgation and maintenance of performance measures, the submission of data by providers, and public reporting of performance information. Payment Incentives Report This report will identify and analyze options for aligning Medicare payment policies with provider performance in the original fee-for-service program (under parts A and B of Title XVIII of the Social Security Act)
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ensuring a level playing field through oversight and public reporting. RECOMMENDATIONS FOR ACHIEVING A NATIONAL PERFORMANCE MEASUREMENT AND REPORTING SYSTEM Based on its careful analysis of alternatives for achieving a national performance measurement and reporting system, the committee recommends the establishment of a new independent board, the National Quality Coordination Board (NQCB)
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The NQCB should produce useful information for three purposes that address different audiences: · Accountability -- Information should be available to assist stakeholders in making choices about providers. These stakeholders include patients identifying a clinician, hospital, or other provider from which to seek services; purchasers and health plans selecting providers to include in their health insurance networks; and quality oversight organizations making accreditation and certification decisions.
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to focus on the achievement of all applicable national goals established by the NQCB through public reporting, payment reform, and other incentives such as health care improvement programs, benefit design, health professions edu
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performance data that can be used by Medicare for public reporting and quality improvement activities or as a basis for payment. In addition, Congress should activate an interagency task force to explore mechanisms for aligning other government health care programs with these efforts -- including the Department of Defense (DoD)
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Perfor mance measurement, improvement, and reporting activities- including those of public and private purchasers; accreditation and certification entities; and federal, state, and local government programs -- should be substantially aligned with the national goals and standardized measures established by the NQCB, but local communities should also be encouraged to identify and pursue local priorities, in addition to helping to achieve national goals. A RECOMMENDED STARTER SET OF PERFORMANCE MEASURES The committee recommends that the NQCB build upon the substantial scientifically grounded gains that have already been made by various stakeholder groups committed to the development and promulgation of performance measures by immediately upon its inception endorsing the leading measure sets listed in Table ES-2 as national standards.
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11 (2) , a staff (8)
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· Ensure that technical and financial assistance is available to all providers who need help in establishing performance measure ment and improvement capabilities. The committee also believes that while the leading measure sets provide an excellent springboard, they are inadequate to drive the health sector toward the transformational changes envisioned in the Quality Chasm.
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The committee recommends moving toward individual patient-level measurement, even for the starter set of measures, because of the markedly increased value and flexibility offered by this approach. This approach to data collection would allow for aggregation along three important dimensions: (1)
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development, implementation, and evaluation of new measures to address current gaps; (2) applied research to address underlying methodological issues; (3)
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Because payment incentives, public reporting, and quality improvement initiatives all require the existence of meaningful and valid performance measures, their potential impact would be limited by a constrained, fragmented, and ineffective measurement system. Yet without strong, central leadership, individual stakeholders will have great difficulty in acting together voluntarily to create the kind of system that is needed.
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:26352645. President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
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