Performance Measurement Accelerating Improvement (2006) / Chapter Skim
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3 Achieving a National System for Performance Measurement and Reporting
3 Achieving a National System for Performance Measurement and Reporting
Pages 63-82
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From page 63... ...
has implemented several system changes targeted at improving the quality of care, including measuring and tracking performance on a comprehensive set of indicators. In a cross-sectional comparison of 12 VHA health care systems versus a representative national sample, VHA patients were found to receive higherquality care than their counterparts in the areas of overall quality, chronic disease care, and preventive care.
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From page 64... ...
The Centers for Medicare and Medicaid Services (CMS) , the private sector, and Congress are all committing substantial resources to performance measurement, public reporting, and quality improvement initiatives, and are now embarking on pay for performance initiatives.
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From page 65... ...
The advantage of this option is that all of the resources needed to create a national system for performance measurement and reporting would be housed under one roof and supported by a single stream of funding. However, the committee believes this option is not preferable for several reasons.
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From page 66... ...
As described in Chapter 2, current private-sector efforts have made substantial progress in shaping and advancing the field of performance measurement in health care. For example, NQF has a reputable track record in endorsing standardized performance measures, while NCQA and JCAHO have rich histories in the development of standardized measures and the public reporting of comparative quality data.1 In addition to these competencies, however, the committee identified additional functions of a national system that are unlikely to be realized through private-sector efforts alone, as they are framed from the perspective of a public good.
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From page 67... ...
Although a large federal entity could assume all the necessary functions for a national performance measurement and reporting system, the committee TABLE 3-1 Comparison of Alternatives for Achieving a National System for Performance Measurement and Reporting Alternative 2: Alternative 3: Alternative 1: Office Within Other Alternative 4: Key Functions of a Large Federal CMS or Stakeholder Independent National System Entity AHRQ Groups Board Specify purpose and aims Prioritize national goals Promulgate standardized measures Ensure data collection, validation, and aggregation Establish public reporting methods responsive to the needs of all stakeholders Identify a research agenda Evaluate impact of overall system
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From page 68... ...
· Evaluate the impact of performance measurement on pay for performance, quality improvement, public reporting, and other policy levers. The NQCB should be composed of health care leaders capable of understanding the diverse sectors within the health care system, such as consumers, purchasers, educators, clinicians from all disciplines (medicine, nursing, pharmacy)
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From page 69... ...
Standardizing performance measurement and establishing a useful, bold, and transparent national system for setting goals and reporting on progress will require a difficult transition for many stakeholders in American health care. Although almost all parties -- especially patients -- will benefit in the end from better measurement and reporting, many of the current stakeholders can initially be expected to defend the status quo.
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From page 70... ...
Despite numerous efforts over several decades to improve the nation's health care performance assessment, no effective system yet exists. An NQCB that can lead the development of a truly effective system of performance measurement and reporting will have to possess a high level of independence and authority if it is to accomplish its purpose.
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From page 71... ...
· Substantive expertise. As noted above, the committee's intention is not to supplant or duplicate the often outstanding work of the many organizations currently involved in developing, evaluating, vetting, and implementing performance measures in health care.
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From page 72... ...
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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From page 73... ...
As discussed earlier in the chapter, the primary role of NQF, as now structured, is to endorse standardized performance measures -- an important function for a national system. NQF has relatively small revenues ($4 million annually)
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From page 74... ...
. In promulgating standardized performance measures, the NQCB will need evidence on the scientific soundness of the various measures under consideration (e.g., whether claims data can be used to assess whether a particular clinical process was performed on those patients who would likely benefit from it or was performed properly)
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From page 75... ...
. Local communities might also be encouraged to undertake locally driven quality improvement initiatives in addition to pursuing national goals.
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From page 76... ...
. Overall, the committee believes the NQCB will be far more effective in achieving its purpose and aims if standardized performance measure sets are comprehensive enough to support the efforts of many stakeholders-both those external to health care organizations (i.e., purchasers, planners)
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From page 77... ...
For example, if performance measures are adjusted for a patient's complicating and comorbid conditions, providers may inflate the list of secondary diagnoses to include conditions that are inactive or those yet to be confirmed. · Stifled innovation -- There is always the potential for innovation to be stifled through the imposition of a more structured process for setting goals and focusing quality improvement efforts.
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From page 78... ...
The NQCB is a threat to The NQCB will ensure appropriate confidentiality protecpatient privacy. tions for patient data in strict compliance with regulations of the Health Insurance Portability and Accountability Act.
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From page 79... ...
a phased approach to implementation to ensure that data collection tools and approaches are efficient and supported by electronic health records (EHRs)
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From page 80... ...
The NQCB will need to be diligent in ensuring that appropriate confidentiality protections are in place for the submission of patient data that are in strict compliance with the regulations of the Health Insurance Portability and Accountability Act. The board will also need to address the potential problem of patients opting not to have their data included in a data repository and the impact this would have on the
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From page 81... ...
The NQCB Will Stifle Local Quality Improvement Efforts As with any national compulsory structure, there could be concern that the NQCB will pose a threat to innovative local quality improvement initiatives and programs. Many regions of the country are developing advanced performance measurement systems, and some stakeholders may be concerned that the NQCB will establish a ceiling, thus precluding their own quality improvement targets and local priorities.
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From page 82... ...
2005. The value of electronic health records in solo or small group practices.
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