Performance Measurement Accelerating Improvement (2006) / Chapter Skim
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1 Introduction
1 Introduction
Pages 17-39
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. The IOM project Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, initiated in 2004, is focused at the environmental level.
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(A) shall encompass a variety of perspectives, including physicians, hospitals, other health care providers, health plans, purchasers, and patients.
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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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Before proceeding, however, the committee notes that while much of the interest in enhancing the quality of health care is driven by a desire to reduce the costs associated with unnecessary or wasteful practices, the rate of increase in health care costs cannot be slowed by enhancements to health insurance programs alone. Many other factors contribute to rapidly rising health care costs, most notably advances in medical knowledge and technology, as well as an aging population eager to take advantage of these advances to extend and improve the quality of life.
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THE CURRENT HEALTH CARE LANDSCAPE The U.S. health care system provides some of the most scientifically advanced care in the world.
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. And a study assessing patients treated in academic health centers for acute myocardial infarction, colorectal cancer, and hip fracture found that the centers differed in intensity of services delivered by up to 60 percent, but that higher-intensity practice was associated with either no difference or, for some conditions, a small decrement in care quality and patient outcomes (Fisher et al., 2004)
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. The escalating cost of health insurance not only consumes a sizable proportion of gross national product, but also contributes to rising numbers of uninsured -- nearly 45 million people in 2003, or about one in seven Americans (Fronstin, 2004; Kaiser Family Foundation, 2004c)
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. Associated with rural as compared with urban communities are single providers, lower rates of health insurance, poorer health behaviors, higher infant mortality, and greater incidence of chronic diseases (Kaiser Family Foundation, 2004c)
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. Between 2000 and 2003, the Medicare Quality Improvement Organization Program supported quality improvement projects in all states, often reaching all hospitals, nursing homes, home health agencies, and outpatient physicians in the state, with varying degrees of involvement (AMA, 2000; U.S.
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. This environment, which is shaped to a great extent by the design of public and private health insurance programs, fails to produce incentives or structures that encourage and reward high-quality care (Nichols et al., 2004)
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The availability of information on the quality of commercial or self-insured health plans is variable. Many health plans report performance information on a set of standardized quality measures.
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. CMS has played a leadership role in establishing public reporting systems for nursing homes, home health agencies, dialysis centers, and, most recently, hospitals (CMS, 2005a)
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. Many private purchasers and health plans are also implementing pay for performance programs that generally link a modest amount of provider payments to performance across a number of measures (Rosenthal et al., 2004)
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While each of these proposals is based on a different set of assumptions and values with regard to the fundamental processes and interactions that would best foster the common good, all would require performance measures to achieve their goals. This IOM report proposes a set of measures, derived from an evidentiary base, that the committee believes can be used for multiple purposes: data collection and analysis, public reporting, development of professional standards, payment and benefit design, governmental oversight, and purchasing benchmarks.
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. Although performance data are integral to the success of efforts targeting public disclosure of performance data, payment policies, and performance improvement processes, currently available performance data on many types of providers are quite limited.
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results in an excessive burden on providers and weakens the impact of incentives for quality improvement. In sum, a national strategy for the measurement and reporting of provider performance is a fundamental building block in the efforts of all stakeholders to improve health care quality through public reporting, ongoing quality improvement, pay for performance programs, quality-based benefit design, and health insurance purchasing benchmarks.
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2004a. National Healthcare Quality Report.
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2005a. Medicare Compare Series: Nursing Home Compare, Home Health Compare, Dialysis Compare, and Hospital Compare.
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2004. Sources of health insurance and characteristics of the uninsured: Analysis of the March 2004 current population survey.
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2004c. Health Insurance Coverage in America: 2003 Data Update.
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2002. Impact of race on cardiac care and outcomes in veterans with acute myocardial infarction.
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2003. VA's Electronic Health Records System Pushing National Standards.
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2005. Variation in Use of Medicare Services Among Regions and Selected Aca demic Medical Centers: Is More Better?
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