[Federal Register Volume 78, Number 148 (Thursday, August 1, 2013)]
[Notices]
[Pages 46696-46731]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-18478]
[[Page 46695]]
Vol. 78
Thursday,
No. 148
August 1, 2013
Part II
Department of Health and Human Services
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Secretarial Review and Publication of the Annual Report to Congress
Submitted by the Contracted Consensus-Based Entity Regarding
Performance Measurement; Notice
Federal Register / Vol. 78, No. 148 / Thursday, August 1, 2013 /
Notices
[[Page 46696]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Secretarial Review and Publication of the Annual Report to
Congress Submitted by the Contracted Consensus-Based Entity Regarding
Performance Measurement
AGENCY: Office of the Secretary of Health and Human Services, HHS.
ACTION: Notice.
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SUMMARY: This notice acknowledges the Secretary of the Department
of Health and Human Services' (HHS) receipt and review of the Annual
Report submitted to the Secretary and Congress by the contracted
consensus-based entity (CBE) as mandated by section 1890(b)(5) of the
Social Security Act, as created by section 183 of the Medicare
Improvements for Patients and Providers Act of 2008 (MIPPA) and amended
by section 3014 of the Affordable Care Act of 2010. The statute
requires the Secretary to review and publish the report in the Federal
Register together with any comments of the Secretary on the report not
later than six months after receiving the report. This notice fulfills
those requirements.
FOR FURTHER INFORMATION CONTACT: Ann Page (202) 260-6473.
I. Background
Rising health care costs coupled with the growing concern over the
level of and variation in quality and efficiency in the provision of
health care raise important challenges for the United States. Section
183 of MIPPA created Section 1890 of the Social Security Act, which
requires the Secretary of the Department of Health and Human Services
(HHS) to contract with a consensus-based entity to perform multiple
duties pertaining to health care performance measurement. These
activities support HHS's efforts to promote high-quality, patient-
centered, and financially sustainable health care. The statute mandates
that the contract be competitively awarded for a period of four years
and may be renewed under a subsequent bidding process.
In January, 2009, a competitive contract was awarded by HHS to the
National Quality Forum (NQF) for a four-year period. The contract
specified that the CBE should conduct its business in an open and
transparent manner, provide the opportunity for public comment and
ensure that membership fees do not pose a barrier to participation in
the scope of HHS's contract activities, if applicable.
The HHS four-year contract includes the following major tasks:
Priority Setting Process: Formulation of a National Strategy and
Priorities for Health Care Performance--The CBE shall synthesize
evidence and convene key stakeholders to make recommendations on an
integrated national strategy and priorities for health care performance
measurement in all applicable settings. The CBE shall give priority to
measures that: Address the health care provided to patients with
prevalent, high-cost chronic diseases; provide the greatest potential
for improving quality, efficiency and patient-centered health care; and
may be implemented rapidly due to existing evidence, standards of care
or other reasons. Additionally, the CBE shall take into account
measures that: May assist consumers and patients in making informed
health care decisions; address health disparities across groups and
areas; and address the continuum of care across multiple providers,
practitioners and settings.
Endorsement of Measures: Implementation of a Consensus Process for
Endorsement of Health Care Quality Measures--The CBE shall provide for
the endorsement of standardized health care performance measures. This
process shall consider whether measures are evidence-based, reliable,
valid, verifiable, relevant to enhanced health outcomes, actionable at
the caregiver level, feasible to collect and report, and responsive to
variations in patient characteristics such as health status, language
capabilities, race or ethnicity, and income level and is consistent
across types of health care providers including hospitals and
physicians.
Maintenance of Consensus Endorsed Measures--The CBE shall establish
and implement a process to ensure that endorsed measures are updated
(or retired if obsolete) as new evidence is developed.
Promotion of the Development of Electronic Health Records--The CBE
shall promote the development and use of electronic health records that
contain the functionality for automated collection, aggregation, and
transmission of performance measurement information. However, in
January of 2013, this task was repealed and, as a result, removed from
the CBE's statutory duties by the American Taxpayer Relief Act (Pub. L.
112-240, Title VI, Sec. 609(a)(2)).
Convening Multi-Stakeholder Groups--The CBE shall convene multi-
stakeholder groups to provide input into the selection of certain
categories of quality and efficiency measures, including measures for
use in certain specific Medicare programs, for use in programs that
report performance information to the public, and for use in health
care programs that are not included under the Social Security Act. The
multi-stakeholder groups consider measures to be implemented through
the federal rulemaking process for various federal health care quality
reporting and quality improvement programs including those that address
certain Medicare services provided through hospices, hospital inpatient
and outpatient facilities, physician offices, cancer hospitals, end
stage renal disease (ESRD) facilities, inpatient rehabilitation
facilities, long-term care hospitals, and psychiatric hospitals and
home health care programs.
Annual Report to Congress and the Secretary--Under section
1890(b)(5)(A) of the Act, by not later than March 1 of each year
(beginning with 2009) the CBE shall submit to Congress and the
Secretary of HHS an annual report. The report shall contain a
description of:
(i) The implementation of quality and efficiency measurement
initiatives and the coordination of such initiatives with quality and
efficiency initiatives implemented by other payers;
(ii) recommendations on an integrated national strategy and
priorities for health care performance measurement;
(iii) performance of its duties required under its contract with
HHS;
(iv) gaps in endorsed quality and efficiency measures, which shall
include measures that are within priority areas identified by the
Secretary under the National Quality Strategy established under section
399HH of the Public Health Service Act (National Quality Strategy), and
where quality and efficiency measures are unavailable or inadequate to
identify or address such gaps;
(v) areas in which evidence is insufficient to support endorsement
of quality and efficiency measures in priority areas identified by the
Secretary under the National Quality Strategy, and where targeted
research may address such gaps; and
(vi) the convening of multi-stakeholder groups to provide input on:
(1) The selection of quality and efficiency measures from among such
measures that have been endorsed by the CBE and such measures that have
not been considered for endorsement by the CBE but are used or proposed
to be used by the Secretary for the collection or reporting of quality
and efficiency measures; and (2) national priorities for improvement in
population health and the delivery of health care services for
consideration under the National Quality Strategy.
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Section 1890(b)(5)(B) of the Social Security Act requires
Secretarial review and publication of this report in the Federal
Register, together with any comments of the Secretary on the report not
later than 6 months after receiving the report.
The first annual report covered the performance period of January
14, 2009 to February 28, 2009 or the first six weeks post contract
award. In March 2009, NQF submitted the first annual report to Congress
and the Secretary of HHS. Given the short timeframe between award and
the statutory requirement for the submission of the first annual
report, this first report provided a brief summary of future plans. The
Secretary published a notice in the Federal Register in compliance with
the statutory mandate for review and publication of the annual report
on September 10, 2009 (74 FR 46594).
In March 2010, NQF submitted to Congress and the Secretary the
second annual report covering the period of performance of March 1,
2009 through February 28, 2010. The second annual report was published
in the Federal Register on October 22, 2010 (75 FR 65340) to comply
with the statutorily required Secretarial review and publication.
In March 2011, NQF submitted the third annual report to Congress
and Secretary of HHS. The third annual report, which covers March 1,
2010 through February 28, 2011, was published in the Federal Register
on September 7, 2011 (76 FR 55474).
In March 2012, NQF submitted its fourth annual report to Congress
and the Secretary. The report covers the period of performance of
January 14, 2011 through January 13, 2012. The fourth annual report was
published in the Federal Register on September 14, 2012 (77 FR 56920).
In March 2013, NQF submitted its fifth annual report to Congress
and the Secretary. The report covers the period of performance of
January 14, 2012 through December 31, 2012. Because the first annual
report covered only six weeks, there have been five annual reports
under this four-year contract. This notice complies with the statutory
requirement for Secretarial review and publication of the fifth NQF
annual report.
II. March 2013--Consensus-Based Entity Report to Congress and the HHS
Secretary
Submitted in March 2013, the fifth annual report to Congress and
the Secretary spans the period of January 14, 2012 through December 31,
2012.
A copy of NQF's submission of the March 2013 annual report to
Congress and the Secretary of HHS can be found at: http://www.qualityforum.org/Publications/2013/03/2013_NQF_Report_to_Congress.aspx. The fifth NQF annual report is reproduced in section III
of this notice.
III. NQF Report of 2012 Activities to Congress and the Secretary of the
Department of Health and Human Services
This report was funded by the U.S. Department of Health and Human
Services under contract number: HHSM-500-2009-00010C.
1. Executive Summary
In the last six years, Congress passed statutes that call upon HHS
to work with a consensus-based entity (the entity) to facilitate multi-
stakeholder input into (1) setting national priorities for improvement
in quality and (2) recommending use of performance measures in federal
programs to achieve these priorities. The statutes also call upon a
consensus-based entity to review and endorse a portfolio of
standardized performance measures to be used by stakeholders in public
and private quality improvement and accountability programs. Note: The
relevant statutory language appears in italicized text throughout this
report. The first of these statutes is the 2008 Medicare Improvements
for Patients and Providers Act (MIPPA) (PL 110-275), which established
the responsibilities of the consensus-based entity by creating section
1890 of the Social Security Act and was passed under President Bush.
The second statute is the 2010 Patient Protection and Affordable Care
Act (ACA) (Pub. L. 111-148), which modified and added to the consensus-
based entity's responsibilities, and was passed under President Obama.
The 2013 American Taxpayer Relief Act (Pub. L. 112-240) extended
funding under the MIPPA statute to the consensus-based entity through
fiscal year 2013. HHS awarded contracts related to the consensus-based
entity identified in the statute to the National Quality Forum (NQF).
As amended by the above laws, the Social Security Act (the Act)--
specifically section 1890(b)(5(A))--also mandates that the entity
report to Congress and the Secretary of the Department of Health and
Human Services (HHS) no later than March 1st of each year. The report
must include descriptions of: (1) How NQF has implemented quality and
efficiency measurement initiatives under the Act and coordinated these
initiatives with those implemented by other payers; (2) NQF's
recommendations with respect to activities conducted under the Act on
an integrated national strategy and priorities for healthcare
performance measurement in all applicable settings; (3) NQF's
performance of the duties required under its contract with HHS; (4)
gaps in endorsed measures that NQF has identified, including measures
that are within priority areas identified by the Secretary under HHS'
national strategy; (5) areas NQF has identified in which evidence is
insufficient to support endorsement of measures in priority areas
identified by the National Quality Strategy, and where targeted
research may address such gaps, and (6) the matters described in
clauses (i) and (ii) of paragraph (7)(A) of section 1890(b). To address
the last item, the report will cover the new multi-stakeholder group
input duties for the consensus-based entity as outlined in section
3014(a), which created section 1890(b)(7) and (8) of the Act. The first
of these duties includes providing multi-stakeholder input on the
selection of quality and efficiency measures both endorsed and those
not endorsed by the entity, that are used or proposed to be used by the
Secretary for collection or reporting of quality and efficiency
measures. The second duty requires that the consensus-based entity
provide multi-stakeholder group input on national priorities for
improvement in population health and in the delivery of healthcare
services for consideration under the National Quality Strategy.
This fourth Annual Report highlights NQF's work conducted between
January 14, 2012 and December 31, 2012 related to these statutes and
conducted under a federal contract with the U.S. Department of Health
and Human Services.The deliverables produced under contract in 2012 are
referenced throughout this report, and a full list is included in
Appendix A.
Facilitating Coordinated Action To Achieve the National Quality
Strategy
Section 1890(b)(1) of the Social Security Act mandates that the
entity shall synthesize evidence and convene key stakeholders to make
recommendations on an integrated national strategy and priorities for
healthcare performance measurement in all applicable settings. In
making such recommendations, the entity shall ensure that priority is
given to measures: that address the health care provided to patients
with prevalent, high-cost, chronic diseases; that focus on the greatest
potential for improving the quality, efficiency, and patient-
centeredness of healthcare; and that
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may be implemented rapidly due to existing evidence and standards of
care. In addition, the entity will take into account measures: that may
assist consumers and patients in making informed healthcare decisions;
address health disparities across groups and areas; and address the
continuum of care a patient receives, including services furnished by
multiple healthcare providers or practitioners and across multiple
settings.
Under section 1890(b)(5)(A)(ii) of the Social Security Act, the
entity is mandated to include in the annual report a description of the
recommendations it has made, with respect to activities conducted under
the Social Security Act, on an integrated national strategy, and
priorities for healthcare performance measurement in all applicable
settings.
Since 2009, the NQF-convened National Priorities Partnership (NPP)
has helped to provide multi-stakeholder input into the selection of
high-impact goals, related priorities, and subsequent strategies that
constitute the first-ever National Strategy for Quality Improvement in
Healthcare (NQS). Released in 2011, the NQS outlines three specific
aims for the U.S. healthcare system--better care, healthy people and
communities, and affordable care. To achieve these aims, the NQS
established six priorities to help the healthcare community focus their
efforts, including:
Making care safer by reducing harm caused in the delivery
of care;
Ensuring that each person and family are engaged as
partners in their care;
Promoting effective communication and coordination of
care;
Promoting the most effective prevention and treatment
practices for the leading causes of mortality, starting with
cardiovascular disease;
Working with communities to promote wide use of best
practices to enable healthy living; and
Making quality care more affordable for individuals,
families, employers, and governments by developing and spreading new
healthcare delivery models.
The NPP is a collaborative public-private partnership of more than
50 organizations that have a shared stake in how healthcare is
delivered, received, and paid for. NPP continues to advise HHS on how
to evolve the NQS' three aims, and its counsel was well reflected in
HHS's 2012 National Strategy for Quality Improvement in Healthcare, an
annual NQS progress report required by Congress.
Beyond forging agreement at the strategic goal level, it is
challenging to get leaders to implement agreed-upon strategies at the
care delivery and community level, given limited time and resources. In
2012, NPP focused on how to advance patient safety by aligning its work
with HHS' ``Partnership for Patients'' effort. Through a series of web-
based and in-person meetings that NPP hosted throughout 2012, nearly
2,700 participants from multiple sectors were able to learn about and
share new improvement approaches, information, tools, and professional
connections to accelerate their individual contributions to achieving
safety related improvements. At a more detailed level, NPP developed
action plans to focus a range of national and local organizations in
diverse sectors on how to align efforts to reduce preventable
readmissions and improve maternity care, relying on proven
interventions. NPP also created a web-based system or ``action
registry'' to track related commitments to improvement activities
focused on readmissions and maternity care to enable learning across
participants. Launched in the fourth quarter of 2012, the registry now
houses over 50 actions by 30 different organizations.
Endorsing and Maintaining Measures, Related Tools, and Information
Under section 1890(b)(2) of the Social Security Act, the entity
must provide for the endorsement of standardized healthcare performance
measures. As part of the endorsement process, NQF is required to
consider whether measures are evidence-based, reliable, valid,
verifiable, relevant to enhanced health outcomes, actionable at the
caregiver level, feasible for collecting and reporting data, responsive
to variations in patient characteristics, and consistent across
healthcare providers. In addition, under section 1890(b)(3), the NQF
must maintain endorsed measures, by establishing and implementing a
process to ensure that endorsed measures are retired if obsolete or
brought up to date as new evidence is developed.
NQF strategically manages its portfolio of 700-plus endorsed
measures to increase impact and decrease burden, growing the portfolio
in some areas and shrinking it in others. More specifically, it
replaces existing measures with those that are better, reflect new
medical evidence, or are more relevant; removes measures that are no
longer effective or where the evidence base has evolved; and expands
the portfolio to address well-recognized measurement gaps.
The NQS priorities guide the management of the measure portfolio by
NQF expert committees. In addition to concentrating on endorsing
measures suitable for public reporting, performance-based payment, and
other accountability purposes, NQF evolves its portfolio so that the
measures are also clinically relevant and actionable for providers.
Payers and patients are interested in measures that they can use to
compare and select providers; clinicians and hospitals seek clinically
relevant measures to benchmark themselves against so they have the
information they need to focus their improvement efforts for the
benefit of their patients. A mix of measures is essential to creating
and continuously evolving a portfolio that meets the needs of diverse
stakeholders.
In 2012, NQF completed 16 endorsement projects--reviewing 430
submitted measures and endorsing 301 measures, or 70 percent. This set
included 81 new measures and 220 measures that maintained their
endorsement after being considered in light of new evidence and/or
against new competing measures submitted to NQF for consideration. The
newly endorsed measures align with needs identified in the NQS and
address several critical areas, including patient outcomes, underserved
populations, healthcare disparities, and hospital readmissions.
In comparison, NQF completed 11 projects and endorsed 170 measures
in 2011. This increased productivity can be attributed to efforts to
make the review process more efficient--the average measure review time
decreased from 12 months to 7 months during 2012--as well as to other
enhancements to the endorsement process. Specifically, as part of the
Consensus Development Process pilot program, NQF provided earlier, more
detailed feedback to measure developers about a first-order criterion
(i.e., importance to measure) to further the goal that development
dollars are spent on measures that are viewed as consequential by the
field. Furthermore, when a measure is re-evaluated for continued
endorsement, NQF now requires committees to consider the measure's use
and whether such use has resulted in improvement or has led to
unintended consequences, ensuring that committee members are informed
about the measure's impact.
Under section 1890(b)(4) of the Social Security Act, the entity has
been responsible for promoting the development and use of electronic
health records (EHRs) that contain the functionality for automated
collection,
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aggregation, and transmission of performance measurement information.
In an effort to move beyond measures that rely on administrative
data or that are collected from paper-based medical records, NQF
continued its work in 2012 to facilitate the development and reporting
of electronic measures, or eMeasures, that can help accelerate the
adoption of electronic health records (EHRs). Such efforts include work
at the granular level (e.g., standardizing data elements so they can be
collected from varied EHRs to build eMeasures) and at the more
conceptual level (e.g., the NQF-convened eMeasure Learning
Collaborative). Created by NQF at the behest of measure developers, EHR
vendors, HHS, and clinicians, the eMeasure Learning Collaborative is a
forum for sharing best practices and tackling issues that are barriers
to developing and implementing eMeasures, such as figuring out how to
enhance ``upstream'' communication between measure developers and other
stakeholders so that affected parties have the opportunity to
collaborate on data requested and its representation in eMeasure logic
during the measure development process. In 2012, NQF also launched the
Health IT Knowledge Base and glossary to facilitate a unified
understanding of terms and measurement approaches used in EHRs and more
broadly, health IT, and to disseminate best practices, among other
projects.
Aligning Accountability Measures To Enhance Value
Under section 1890(b)(1) of the Social Security Act, the entity
shall synthesize evidence and convene key stakeholders to make
recommendations and priorities for healthcare performance measurement
in all applicable settings.
Under section 1890(b)(5)(A)(i) of the Social Security Act, the
entity must report on the implementation of quality and efficiency
measurement initiatives under the Social Security Act and the
coordination of these initiatives with quality and efficiency
initiatives implemented by other payers.
Under section 1890(b)(7) of the Social Security Act, NQF is
specifically responsible for convening multi-stakeholder groups to
provide input to the Secretary of HHS on the selection of certain
categories of NQF-endorsed and non-endorsed quality and efficiency
measures (measures NQF has not considered for endorsement but the
Secretary uses or is proposing to use for the collection or reporting
of quality and efficiency measures). Beginning in 2012, NQF has been
required to transmit the input of the multi-stakeholder groups to the
Secretary not later than February 1st of each year. Under section
1890(a)(5), the Secretary must consider multi-stakeholder input as part
of a pre-rulemaking process the Secretary must complete prior to the
adoption of measures during the Federal rulemaking process. NQF
provides this multi-stakeholder input through its Measure Applications
Partnership (MAP).
Agreement about how to define quality, safety, and costs in a
portfolio of endorsed measures is an important first step toward
measure alignment, which then needs to be followed by consensus across
stakeholder groups about the use of endorsed measures.
The NQF-convened MAP--which comprises stakeholders from a wide
array of healthcare sectors and 10 federal agencies, as well as 110
subject matter experts--focuses on recommending measures for federal
public reporting, payment, and other programs to enhance healthcare
value. As part of its mission, MAP also strives for alignment with the
private sector on the use of such measures. In February 2012, MAP
provided multi-stakeholder input to HHS about the considered use of
measures in over 17 different federal Medicare benefit programs and the
Electronic Health Record (EHR) Incentive Program as a part of its first
annual pre-rulemaking report required by statute. This input was well-
heeded, as evidenced by a degree of concordance--or agreement between
MAP's recommendations and the Centers for Medicare & Medicaid Services
(CMS) final rules for quality reporting, public reporting, and value-
based purchasing programs issued in 2012--which averaged 70 percent
concordance across programs.\1\ Where discordance exists, it appears to
be due to timing. For example, in some cases, such as the Physician
Quality Reporting System (PQRS), CMS is moving measures rapidly into a
program to encourage clinician participation and concurrently
encouraging that these measures be reviewed by NQF for possible
endorsement.
To help guide future measure development related to the NQS and to
inform use of measures in value-based programs going forward (including
future annual pre-rulemaking reports to HHS), MAP released a Strategic
Plan for Measurement in October 2012. A key part of the plan focuses on
defining the concept of ``families of measures'' in high-impact areas,
some of which cross conditions and settings. The objective of these
families, or sets of measures, is to knit together related measures
currently found in different programs, care settings, levels of
analysis, and populations to drive improvement and reduce measurement
burden. In addition, the plan calls for further engagement of
stakeholders to glean additional feedback about measure use and
usefulness.
At the same time, MAP released its Families of Measures report,
which defines measure families in four key areas--safety, care
coordination, cardiovascular, and diabetes care--with the goal of
promoting more cohesion and integration of care regardless of setting,
provider, level of intensity, or timing. An additional and equally
important goal is reducing measurement and reporting burden through
alignment for hospitals, physicians, and other providers as it relates
to these four areas.
A 2012 NQF analysis (conducted outside of the federal contract) of
NQF-endorsed measures in use shows that about 29 percent of measures
are being used by two or more key stakeholders simultaneously,
including the federal government, private payers, states, communities,
and other users. Given its size and reach, the federal government is an
important driver, using more than half of NQF's measure portfolio in
its various pay-for-reporting and pay-for-performance programs,
followed by private payers and states using 41 percent and 28 percent,
respectively. Further, NQF's analysis shows that alignment in use of
the same measures increased across these key sectors between 2011 and
2012.2 3 A 2011 RAND study of 75 organizations revealed a
strong preference for NQF-endorsed measures where they exist because
they are vetted, evidence-based, and known to be more credible with
providers.\4\
Filling Measurement Gaps
Under section 1890(b)(5)(A)(iv) of the Social Security Act, the
entity is required to report on gaps in endorsed quality and efficiency
measures including measures within priority areas identified by HHS
under the agency's National Quality Strategy, and where quality and
efficiency measures are unavailable or inadequate to identify or
address such gaps. Under section 1890(b)(5)(v) of the Social Security
Act, NQF is also required to report on areas in which evidence is
insufficient to support endorsement of quality and efficiency measures
in priority areas identified by the Secretary under the National
Quality Strategy and where targeted research may address such gaps.
The science of performance measurement continues to evolve in
response to the needs and preferences of
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various stakeholders, new and updated data platforms, the capacity of
providers to collect and report measures, and other factors. In 2012,
NQF conducted an extensive analysis of its current measures portfolio
against both the National Quality Strategy priority areas and high-
impact conditions to meet requirements under section 1890(b)(5)(A)(iv)
of the Social Security Act. This analysis provides a more in-depth
understanding of what NQF-endorsed measures exist against key strategic
frameworks, which of these measures are being used in the field, and
where gaps persist--either because the measures have not yet been
developed or they are in existence but are not being used.
The extent to which each NQS priority at the goal level has NQF-
endorsed measures available to drive change is varied but generally
promising. For example, a large part (40%) of the NQF portfolio
addresses the important area of patient safety which includes
healthcare acquired conditions and hospital readmissions. Fewer
measures (7 percent) address patient and family engagement. Overall,
measures for specific goals--including shared decision-making, patient
navigation and self-management, shared accountability, healthy
lifestyle behaviors, community interventions to improve health, and
access, cost, and resource use--are less prevalent.
Looking across both the NQS priority areas and high-impact Medicare
and child health conditions, the analysis found gaps in measures of
preventive care, patient-reported outcomes (particularly quality of
life and functional status), appropriateness (particularly for
specialty care), access to timely palliative care, and health and
healthcare disparities. Additionally, the analysis revealed the need
for better population-level measures to assess improvements in health
and healthcare. An assessment of the NQF portfolio of endorsed measures
revealed that while certain high-impact conditions have an abundance of
measures--e.g., cardiovascular disease, end-stage renal disease, and
diabetes--many of the high-impact childhood conditions have few or no
NQF-endorsed measures. Finally, all but one of the 92 NQF-endorsed
measures in use in federal and at least two other non-federal programs
address a specific NQS goal or a high-impact condition.
While certainly there is room for improvement, the analysis
suggests that the existing portfolio generally addresses agreed upon
frameworks and that there is alignment in use of such measures across
various sectors. Going forward, resources should be dedicated to
delving more deeply into the identified gap areas to prioritize measure
development and endorsement efforts so that the most needed measurement
gaps are addressed first.
Furthermore, NQF's efforts are focused on furthering alignment as
it relates to measurement strategies to enhance healthcare value
through its public-private partnerships and its evidence-based,
consensus-driven method for reviewing and endorsing measures.
Ultimately, however, for the U.S. healthcare system to be transformed,
measurement-driven efforts will need to be mutually reinforced with
changes to current payment and delivery systems that drive the system
toward greater integration and accountability. Only then will we be
able to put the U.S. healthcare system on the path to achieving the
NQS' three, interconnected, and ambitious aims.
2. Facilitating Coordinated Action To Achieve the National Quality
Strategy
Section 1890(b)(1) of the Social Security Act mandates that the
entity shall synthesize evidence and convene key stakeholders to make
recommendations on an integrated national strategy and priorities for
healthcare performance measurement in all applicable settings. In
making such recommendations, the entity shall ensure that priority is
given to measures: That address the healthcare provided to patients
with prevalent, high-cost chronic diseases; that have the greatest
potential for improving the quality, efficiency, and patient-
centeredness of healthcare; and that may be implemented rapidly due to
existing evidence and standards of care. In addition, the entity will
take into account measures that may assist consumers and patients in
making informed healthcare decisions, address health disparities across
groups and areas, and address the continuum of care a patient receives,
including services furnished by multiple healthcare providers or
practitioners and across multiple settings.
The National Quality Strategy (NQS), released in March 2011, set
forth a cohesive roadmap for achieving patient-centered, affordable
care that promotes healthy people and communities (see pages 3-4 for a
more detailed explanation). Upon its release, its authors emphasized
that the national quality strategy requires the active engagement and
support of healthcare stakeholders across the country for quality
improvements and success.
For the increasing number of stakeholders that have committed to
making the NQS a reality, the path and methods to achieve its aims are
not always apparent. Additionally, as the hard work of achieving care
of the highest value accelerates, stakeholders are increasingly
recognizing that performance measurement and quality improvement are
only achievable by working across sectors and organizations, and they
seek effective and efficient ways to connect across the healthcare
delivery system.
The NPP focused its 2012 efforts on bringing diverse people and
organizations together in their pursuit of the NQS, and in conducting
analyses and activities that helped to refine the next critical
priorities of the healthcare community.
Advising on the National Quality Strategy
NPP members called for the creation of the NQS and in 2012
continued to shape its direction by offering input to the HHS
Secretary. In September 2011, HHS asked the NPP to recommend measures
for evaluating progress in achieving the NQS. This input was integrated
into the 2012 National Strategy for Quality Improvement in Healthcare,
an annual NQS progress report required by Congress. The progress report
reflected near-universal agreement with NPP recommendations. Multi-
stakeholder input into the NQS and follow-on work to achieve its goals
embody the spirit of alignment encouraged by the NQS authors, ensuring
that the strategy is informed, embraced, and viewed as achievable by
both public and private sectors. Without this shared vision, progress
is likely to be marred by competing, unfocused, or discordant efforts.
Identifying and Spreading Solutions To Achieve the National Quality
Strategy
Under section 1890(b)(5)(A)(i) of the Social Security Act, the
entity is to provide a description of its implementation of quality and
efficiency measurement initiatives under the Social Security Act and
the coordination of those initiatives with those implemented by other
payers.
In addition to offering multi-stakeholder input on the NQS, the NPP
focused on helping to disseminate proven and scalable solutions for its
implementation; making connections across sectors and between
organizations; and inspiring people to take highly focused,
coordinated, and targeted action. Much of this work happened as part of
the HHS Partnership for Patients patient safety effort, which has two
ambitious and important goals: reducing hospital-
[[Page 46701]]
acquired conditions by 40 percent and preventable hospital readmissions
by 20 percent by the end of 2013.
Establishing the ``who, what, how, and when'' of action is the
first step in solving large-scale challenges that cut across
organizations and sectors. To that end, NPP partners and an extended
network of contributors (more than 750 in total) spent part of 2012
developing these problem-solving pathways--with an initial focus on
fashioning shared solutions to improving maternity care and reducing
preventable readmissions. The NPP selected these two areas for specific
reasons. Current trends in maternity care and readmissions demonstrate
an opportunity for improvement that can simultaneously reduce
unnecessary patient harm and healthcare costs. Both areas also
represent aspects of healthcare ripe for pooling and focusing the
efforts of many--patients and families, providers, payers, and
policymakers, to name a few.
For example, since 1979, the American Congress of Obstetricians and
Gynecologists (ACOG) has advocated for the avoidance of elective
deliveries before 39 completed weeks gestation, yet early elective
inductions are common in the United States despite the known potential
harms for mothers and babies.\5\ Similarly, rates of cesarean section
have risen in recent decades to nearly 32 percent despite potential
harms, including greater likelihood of asthma for the child. In fact,
the cesarean rate is rising fastest among women who are least likely to
benefit--healthy women at low risk of labor and birth complications.\6\
Studies reveal that higher cesarean rates do not lead to improved
outcomes, and rates above 15 percent may do more harm than good.\7\
Furthermore, there is strong evidence to support the need to address
avoidable admissions and readmissions. Almost one in five Medicare
patients discharged from the hospital is readmitted within 30 days,
putting patients at increased risk of complications or infections and
accounting for approximately $15 billion of excess Medicare spending
each year.8 9 10 While some admissions and readmissions are
planned and appropriate, approximately 40 percent of hospital
admissions among nursing home residents may be avoidable.\11\
In addition to these two specific areas of focus, NPP hosted
several larger scale forums on behalf of the Partnership for Patients
in 2012. NPP-hosted forums were designed to identify innovative ways to
help multiple organizations meet Partnership for Patients' safety goals
and to help spread proven patient safety interventions. Without these
exchanges, organizations often find themselves trying to improve in a
vacuum, working with a limited number of ideas and/or interventions, or
struggling to innovate given their human and financial resources. The
structure of these forums, oriented around idea exchanges and sharing
of case studies and examples, fostered efficient information sharing,
so that those on the frontlines of improving patient safety were
supported in their efforts and therefore could more readily effect
change. More than 400 organizations that support the Partnership for
Patients attended these events. The first three meetings were focused
on education regarding the National Quality Strategy and the importance
of alignment between sectors; catalyzing action; and sharing success
stories in achieving patient safety. The November 2012 NPP-Partnership
for Patients event focused exclusively on how to achieve meaningful
patient and family engagement, which is essential for solving all
patient safety issues and achieving a patient-centered healthcare
system. After the first meeting in January 2012, 100 percent of
attendees felt the meeting enhanced their ability to contribute to
public-private sector collaboration. NPP augmented the four in-person
forums with online educational `webinars.' In total, over the course of
2012, nearly 2,700 people from multiple sectors participated in NQF-
hosted webinars and in-person events in support of the Partnership for
Patients.
In 2012, NQF designed a web-based, interactive ``registry'' where
organizations can share information about their own actions to advance
the NQS; search data about the actions of others; find partners to work
with; and learn from others. The registry, available on the NQF Web
site, allowed for broader engagement, participation, and content that
facilitates alignment around a focused set of patient safety activities
and that clarifies who is doing what, when, with whom, and to what end.
Launched in the fourth quarter of 2012, the registry now houses over 50
actions by 30 different organizations.
Deliverables Associated With These Activities
----------------------------------------------------------------------------------------------------------------
Status (as of 1/7/ Notes/scheduled or actual
Description Output 2013) completion date
----------------------------------------------------------------------------------------------------------------
NPP support for Partnership for 4 quarterly convenings for Completed............ Content of meetings and
Patients' HHS initiative focused 100+ people each, and 3 webinars were captured
on patient safety. webinars reaching 550+. in individual summaries.
NPP support for Partnership for 2 public web meetings Completed............ Content of meetings and
Patients' HHS initiative focused reaching 500+ and 2 calls were captured in
on patient safety. public conference calls, individual summaries.
reaching 100+.
NPP support for Partnership for Formed two Action teams Completed............ .........................
Patients' HHS initiative focused around Readmissions and
on patient safety. Maternal Health. Early
development of additional
action teams around
Million Hearts/
Cardiovascular Health and
Patient & Family
Engagement.
NPP support for Partnership for Created the Action Completed............ .........................
Patients' HHS initiative focused Registry, a virtual space
on patient safety. for organizations to
share their quality
improvement activities--
or ``actions''--around
the six priority areas of
the National Quality
Strategy and make
connections with each
other.
NPP support for Partnership for Quarterly reports for HHS. Completed............ .........................
Patients' HHS initiative focused
on patient safety.
----------------------------------------------------------------------------------------------------------------
[[Page 46702]]
3. Supporting National Healthcare Measurement Needs
Under section 1890(b)(2) of the Social Security Act, the entity
must provide for the endorsement of standardized healthcare performance
measures. The endorsement process shall consider whether measures are
evidence-based, reliable, valid, verifiable, relevant to enhanced
health outcomes, actionable at the caregiver level, feasible for
collecting and reporting data, responsive to variations in patient
characteristics, and consistent across healthcare providers. In
addition, under section 1890(b)(3) of the Social Security Act, the NQF
must maintain endorsed measures, including retiring obsolete measures
and bringing other measures up to date.
Standardized healthcare performance measures help clinicians
understand whether the care they offered their patients was optimal and
appropriate, and if not, where to focus their efforts to improve the
care they deliver. Measures are also used by all types of public and
private payers for a variety of accountability purposes, including
feedback and benchmarking, public reporting, and incentive-based
payment. Lastly, measures are an essential part of making healthcare
more transparent to all, important for those who receive care or help
make care decisions for loved ones.
Working with a variety of stakeholders to build consensus, NQF
reviews and endorses healthcare performance measures that underpin
federal and private-sector initiatives focused on enhancing the value
of healthcare services.
Ten years ago, NQF endorsed its first voluntary, national consensus
performance measures to answer the call for standardized measurement of
healthcare services. These first measures were a stepping-stone for
creating a consensus-driven effort that bridged nearly every interested
party in healthcare. The 10-year result of this national experiment is
a portfolio of more than 700 NQF-endorsed measures, most of which are
in use; a more information-rich healthcare system; and a substantial
emerging body of knowledge about measure development, use, and quality
improvement.
In the past five years, NQF, working in partnership with HHS and
others, has focused more intensely on measures that add value and
reduce burden for those who provide, pay for, and receive care. This
movement has been facilitated through more stringent evaluation
criteria that place greater emphasis on evidence and a clear link to
outcomes, demonstrable impact and gaps in care, and testing that
demonstrates measures' reliability and validity. NQF also has laid the
foundation for the next generation of measures, including guidance on
composite measurement, patient-reported outcome measures, disparities-
sensitive measures, electronic or eMeasures, and measures that evaluate
complex but important areas such as resource use and population health.
These activities are intended to inform the path toward targeted,
prioritized measure development.
There is increasing evidence that NQF's stringent criteria,
portfolio management strategies, and collaboration with developers are
having the desired effect on the portfolio. For example, in 2012 we
observed the following:
Guidance that expressed NQF's strong preference for
outcome measures and that required process measures to demonstrate a
clear link to outcomes led to more endorsed outcome measures. At the
end of 2012, 27 percent of the measures in NQF's portfolio were outcome
measures, compared to 24 and 18 percent in 2011 and 2010, respectively.
A focus on harmonization resulted in fewer duplicative
measures, and steering committees selecting the best-in-class measure
whenever possible.
Developers submitted more tested measures--which are more
reliable, valid, and likely to meet NQF endorsement criteria--given
NQF's increased emphasis on requirements for measure testing. With
fewer untested measures to evaluate, steering committees were able to
focus more on evaluating ``better'' measures.
To apply the concept of constant improvement to its own work, NQF
conducted in 2012 Lean improvement activities and other initiatives
and/or projects intended to make the consensus development process more
predictable, efficient, and navigable for those who develop and
evaluate measures, while still maintaining the rigor of its multi-
stakeholder process. Measure developers primarily seek an earlier
window to get broad-based committee input on a measure concept they are
considering investing in; those who use measures are interested in
process changes that may further shrink review cycle time while
maintaining rigor. All parties are focused on ways to make sure finite
measure development resources are used to meet the greatest measurement
needs.
To address these issues, NQF took steps to explore restructuring of
its Consensus Development Process (CDP) in order to provide early
guidance to measure developers on whether a measure concept meets NQF's
criterion for ``importance to measure and report'' before they invest
time and resources to fully develop and test a measure. The results of
the pilot project, often referred to as the ``two-stage CDP,'' will be
available in 2013; results will be used to drive additional
enhancements that meet the critical needs of measure developers.
NQF worked to enhance its approach to harmonization, specifically
helping those who review measures to more consistently and adeptly
recognize an opportunity for aligning measures. In 2012, NQF also
conducted work to help committees evaluate measures for usability, a
criterion for NQF endorsement with which steering committee members
often struggle during deliberations.
Lastly, outside of the HHS process improvement activities around
measure development, NQF created a new multi-stakeholder task force on
consensus, which, working with NQF staff, led a series of focus groups
and research exercises to determine a definition of consensus and how
to establish consensus in rare instances when the NQF membership vote
is split.
Results of NQF's Lean improvement work included reducing the
average measure endorsement cycle time from 12 to 7 months, which is an
important milestone to ensuring that the measures that matter most to
our changing healthcare system are available for use as quickly as
possible all without sacrificing the rigor of the endorsement process.
Other results included the development of standard work for staff,
developers, and committee members. This task force on consensus is
slated to produce findings in early 2013.
Current State of NQF Measures Portfolio: Constricting and Expanding To
Meet Evolving Needs
NQF's measure portfolio includes more than 700 performance
measures, covering a variety of different conditions and care settings.
The portfolio is carefully managed in a variety of ways. First, working
with various expert committees, NQF removes or puts into ``reserve
status'' measures that consistently perform at the highest levels or
``top out.'' This step signals an improvement success and helps to
ensure that time is spent instead measuring areas in need of
improvement. Second, NQF works with those who create measures to
``harmonize'' related or near-identical measures to eliminate nuanced
differences. Harmonization is critical to
[[Page 46703]]
reducing measurement burden for providers, who have been inundated with
various misaligned measurement requests. Successful harmonization may
result in fewer endorsed measures for providers to report and for
payers and consumers to interpret. Lastly, where appropriate, NQF works
with measure developers to replace multiple process measures with more
meaningful outcome metrics. In 2012, NQF removed 103 measures from its
portfolio for a variety of reasons: Measures no longer met endorsement
criteria; measures were harmonized with other similar, competing
measures; or measure developers chose to retire measures they no longer
wished to maintain.
While NQF pursues these proven trimming strategies to make its
measure portfolio appropriately lean, it also aggressively seeks
measures from the field that will help to fill known measure gaps and
to align with the NQS goals. Several important factors motivate NQF to
expand its portfolio, including: (1) The need for eMeasures; (2)
pressure for measures that are applicable to multiple clinical
specialties and settings of care; (3) national pursuit of new payment
models such as bundled payment; and (4) the need for more advanced
measures that help close cross-cutting gaps, such as care coordination
and patient-reported outcomes. The measure portfolio reflects the
combined ``dynamic yet static'' effect of these strategies: Although
the portfolio is constantly changing due to new measures cycling in and
others cycling out, the relative number of endorsed measures remained
steady in 2012. Specifically, 93 measures were added and 103 measures
were removed from the portfolio.
The table below provides a snapshot of how the current NQF-endorsed
measure portfolio aligns with the NQS, with the percentages reflecting
the proportion of NQF-endorsed measures that support each of the six
priorities. Some measures are counted in multiple priority areas. The
table shows gaps in emerging measurement areas, including
affordability, patient- and family-centered care, and community health
and individual well-being. Work conducted in 2012 helped to close these
known measure gaps and to pave the way for innovative measure
development by the healthcare field.
Measures Compared to NQS Priority Areas
------------------------------------------------------------------------
Percentage of
NQS Priority area measures in the
NQF portfolio
------------------------------------------------------------------------
Safety............................................... 27
Person- and Family-Centered Care..................... 5
Prevention and Treatment Practices for Cardiovascular 15
Diseases............................................
Communication and Care Coordination.................. 30
Health and Well-Being................................ 15
Affordability........................................ 8
NQF Portfolio........................................ 100
------------------------------------------------------------------------
Furthermore, seven measure developers account for 64 percent of
NQF's portfolio:
------------------------------------------------------------------------
Percent of
Measure seward/developer Number of total
measures portfolio
------------------------------------------------------------------------
1. Centers for Medicare & Medicaid 123 17
Services...............................
2. National Committee for Quality 116 16
Assurance (NCQA).......................
3. Physician Consortium for Performance 102 14
Improvement (PCPI).....................
4. Agency for Healthcare Research and 56 8
Quality (AHRQ).........................
5. Resolution Health, Inc............... 24 3
6. The Joint Commission................. 24 3
7. ActiveHealth Management.............. 23 3
------------------------------------------------------------------------
Specific Measure Endorsement Accomplishments
In 2012, NQF completed 16 measure endorsement projects--reviewing
430 submitted measures and endorsing 301. These endorsed measures
include 81 new measures and 220 measures that NQF expert committees
concluded could maintain their previous endorsement after being
reviewed against NQF's criteria and compared to new evidence or
competing measures. Overall, measures undergoing maintenance were
endorsed at a rate of 55 percent, and new measures submitted for
endorsement were endorsed at a rate of 89 percent.
Case in point: In the last year clinical projects with a large
number of process measures had markedly lower endorsement rates for
maintenance measures (e.g., perinatal care, 44 percent; pulmonary, 44
percent; and renal disease, 36 percent). Newer measurement areas that
are highly valued by clinicians and patients had higher endorsement
rates, including disparities measures at 75 percent and palliative care
at 64 percent. The disparities measures were primarily outcome
measures, while the palliative measures were primarily process
measures.
The measures endorsed by NQF in 2012 align with needs called out in
the NQS and address several critical areas including patient outcomes,
hospital readmissions, underserved populations, and healthcare
disparities. A complete listing on measures and measurement frameworks
endorsed by NQF in 2012 under contract with HHS is available in
Appendix A. Highlights include the following:
Patient-reported experience measures. The healthcare community is
working toward a more patient-driven system, in which individual needs
and preferences are incorporated into care decisions. Measures that
address patient experience, coupled with clinical measures, allow for a
more comprehensive view of patient care. For example, coupling a
measure that assesses whether post-surgical instructions for care were
clear to the patient and his or her caregiver with measures that assess
hip surgery complication rates creates a more complete picture of a
patient's experience.
In 2012, NQF endorsed several measures addressing patient
experience in various care settings. For example, a measure from the
American College of Surgeons evaluates patient satisfaction during
hospitalization for surgical procedures. A measure from the Agency for
Healthcare Research and Quality focuses on effective provider
communication with patients regarding disease management, medication
adherence, and test results. The American Medical Association developed
seven measures that were endorsed; these measures address concerns such
as individual health literacy, availability of language services, and
patient engagement with providers in clinician offices and acute care
facilities. Finally, measures from the Center for Gerontology and
Health Care Research and the PROMISE Center evaluate how bereaved
family members
[[Page 46704]]
perceive the quality of care provided to loved ones in hospices,
nursing home facilities, and hospitals.
NQF also convened two expert workshops to explore how patient-
reported outcomes (PROs) can be effectively used in performance
measurement. Defined as a patient's health status as reported by the
patient, PROs are seen as the next step forward in building a patient-
centered healthcare system. In the surgical example, a PRO might be
information gleaned from a patient about when she could resume basic
activities of daily living, start exercising, or return to work. The
NQF portfolio already contains some patient-reported outcome measures.
For example, patient reports are the basis of an NQF-endorsed measure
of depression remission six months after treatment developed by
Minnesota Community Measurement. Experiences by community coalitions,
physician practices, and others implementing PROs helped inform NQF
expert committees over the past year as they figured out how to
overcome data, reporting, and methodological barriers to developing and
using PRO-based performance measures.
Readmissions measures. About one in five Medicare beneficiaries who
leaves a hospital is readmitted within 30 days. Such unplanned
readmissions--many of which are potentially preventable--take a
significant toll on patients and their families, often resulting in
prolonged illness or pain, emotional distress, and days of lost work.
These readmissions also cost Medicare about $15 billion annually.\12\
Although Medicare beneficiaries are more likely to be rehospitalized,
the private sector also spends billions of dollars each year on
patients who have an unplanned readmission to the hospital within a
month of an initial stay.
NQF endorsed two hospital-wide, all-cause readmission measures and
three condition-specific readmission measures that can help the
healthcare community better understand and appropriately reduce
hospital readmission rates. These measures align with major safety and
affordability issues. However, as performance measures are increasingly
used in pay-for-performance programs, concerns about the potential for
unintended consequences, such as a negative impact on providers that
care for vulnerable populations, have increased. These issues were
prominent considerations during the 2012 endorsement deliberations over
the hospital-wide, all-cause readmission measure (NQF measure
1789), which was ultimately endorsed. To address multiple
stakeholders' needs and concerns about the newly endorsed readmissions
measures, the NQF Board of Directors issued guidance regarding the use
of hospital-wide measures as it ratified the measure:
Multiple factors affect readmission rates and other measures
including the complexity of the medical condition and associated
therapies; effectiveness of inpatient treatment and care transitions;
patient understanding of and adherence to treatment plans; patient
health literacy and language barriers; and the availability and quality
of post-acute and community-based services, particularly for patients
with low incomes. Readmission measurement should reinforce national
efforts to focus all stakeholders' attention and collaboration on this
important issue.
In response to continued concerns about the use of the new
hospital-wide, all-cause readmission measure (1789), NQF
proposed a series of steps to take place after endorsement of that
particular measure, including monitoring implementation; employing an
expert multi-stakeholder group to review ``dry run'' data provided by
CMS regarding measure 1789; evaluating new readmission
measures for new conditions; and establishing ongoing monitoring
approaches that ensure that more systematic feedback from measure users
is integrated into endorsement deliberations. NQF also reviewed updates
to the readmission measures to remove planned readmissions from the
condition-specific measures that are generally not considered signals
of quality, and is continuing efforts to harmonize hospital and health
plan all-cause readmission measures.
Patient safety measures. Americans are exposed to more preventable
medical errors than patients in other industrialized nations, costing
the United States close to $29 billion per year in additional
healthcare expenses, lost worker productivity, and disability.\13\
These costs are passed on in a number of ways, including higher
insurance premiums and taxes and lost wages. Proactively addressing
medical errors and unsafe care will help to protect patients from harm,
lead to more effective and equitable care, and appropriately reduce
costs.
NQF endorsed 32 patient safety measures in 2012, focusing on
complications such as healthcare-associated infections, falls,
medication safety, and pressure ulcers. These measures closely align
with goals of the Partnership for Patients to make care safer.
Resource use measures. Healthcare expenditures in the United States
are unmatched by any other country. This spending, however, has not
resulted in better health for Americans. In general, the United States
lags behind other countries in terms of mortality, patient
satisfaction, access to care, or quality of care within the healthcare
system.14 15 16 Patients, insurers, state and regional
leaders, federal policymakers, employers, and providers are all attuned
to affordability and increasingly focused on how we can measure and
reduce healthcare expenditures without harming patients.
NQF endorsed its first set of resource use measures--designed to
understand how healthcare resources are being used--in January 2012,
and it endorsed an additional set in April 2012. These measures will
offer a more complete picture of what drives healthcare costs from
several perspectives. For example, one endorsed measure evaluates a
primary care provider's risk-adjusted frequency and intensity of all
services used to manage patients--including inpatient/outpatient,
pharmacy, laboratory, radiology, and behavioral health services--using
standardized prices. Another measure evaluates a primary care
provider's risk-adjusted cost effectiveness at managing his patient
population using actual prices paid by health plans. Similar measures
also evaluate total resources used by individual patients with specific
conditions, such as asthma and chronic obstructive pulmonary disease,
over the course of a measurement year. And other measures evaluate
total costs over an episode of care, such as costs associated with hip/
knee replacement, from diagnosis to treatment to rehabilitation. Used
in concert with quality measures, these resource use measures will
enable stakeholders to identify opportunities for creating a higher
value healthcare system.
Harmonized behavioral health measures. In 2012, NQF endorsed 10
measures related to mental health and substance abuse, including
measures of treatment for individuals experiencing alcohol or drug
dependent episodes; diabetes and cardiovascular health screening for
people with schizophrenia or bipolar disorder; and post-care follow-up
rates for hospitalized individuals with mental illness. As a part of
this process, NQF also brought together CMS and NCQA to harmonize two
related measures into one measure addressing antipsychotic medication
adherence in patients with schizophrenia.
A multiple chronic conditions measurement framework. People with
[[Page 46705]]
multiple chronic conditions (MCCs) now comprise more than 25 percent of
the U.S. population17 18 and this number is expected to
grow. This population is more likely to see multiple clinicians, take
five or more medications, and receive care that is fragmented,
incomplete, inefficient, and ineffective.19 20 21 22 23 They
are at significantly higher risk of adverse outcomes and complications.
Despite the growing prevalence of people with MCCs, existing
quality measures typically do not address issues associated with the
care for individuals with MCCs, largely because of data sharing
challenges and because measures are typically limited to addressing a
singular disease and/or specific setting. As a result, NQF endorsed a
measurement framework that establishes a shared vision for effectively
measuring the quality of care for individuals with MCCs. Measure
developers can use this framework to more quickly create measures for
this population, filling a current measurement gap.
Healthcare disparities measures. Research from the Institute of
Medicine shows that racial and ethnic minorities often receive lower
quality care than their white counterparts, even after controlling for
factors such as insurance coverage, socioeconomic status, and
comorbidities.\24\ Such disparities are exacerbated by additional
factors, including that racial and ethnic minorities have poorer health
status in general, face more barriers to care, and are more likely to
have poor health literacy.
With funding from the Robert Wood Johnson Foundation, NQF
established a more detailed picture of how to approach measurement of
healthcare disparities across settings and populations, beginning with
a commissioned paper outlining methodological concerns. To ensure that
disparities in care can be addressed most effectively, NQF developed an
approach to identify measures that are more sensitive to disparities
and, as such, should be stratified. From there, NQF endorsed 12
performance measures that focused on patient-provider communication,
cultural competence, and language services, among other issues. Now
that these measures are endorsed, HHS has more opportunity to include
these kinds of measures, which address a key NQS measurement priority,
in federal programs.
Streamlining Measure Information
Various healthcare entities gather, store, and need to access
information about performance measures. Over the years, different
measure information systems have been built, each with differing
purposes, structure, and content. This diversity of places and
approaches to storing such information confounds the ability to find
and coordinate pieces of information about a given measure, such as a
specific version, unique identifying number or name, specifications,
purpose and context, and benchmarking results.
HHS asked NQF to use its role as a neutral convener to work with a
variety of public- and private-sector organizations to conduct a
``Registry Needs Assessment.'' The assessment was geared toward
understanding how various stakeholders currently approach gathering and
storing performance measure information; assessing the desirability of
a different approach including but not limited to a single ``measure
registry'' system; and identifying the barriers to achieving more
aligned and definitive ways to store and access consistent and
comprehensive information about measures. The findings included
recommendations for first steps such as developing shared definitions
of measure ``metadata'' and versioning standards to enable alignment of
measure information.
The Global to the Granular: NQF's Role in Accelerating the Adoption of
eMeasures
Under section 1890(b)(4) of the Social Security Act, the entity was
tasked with promoting the development and use of electronic health
records that contain the functionality for automated collection,
aggregation, and transmission of performance measurement information.
Currently, healthcare data largely live within system silos and on
paper rather than in electronic form, which makes it nearly impossible
for data to follow patients through various settings in which they
receive care. Healthcare is safer and better coordinated when
electronic health records (EHRs) and other clinical information
technology systems reliably capture and share data across providers and
patients to facilitate care--and as a byproduct of the clinical
process--generate performance measurement information. Wide adoption of
this kind of electronic infrastructure will spur implementation of the
NQS, but has been hampered by a variety of issues.
NQF's health IT work in 2012 focused on pulling together disparate
organizations that play a role in moving quality from a paper-based
world to one facilitated by technology. The faster we reach consensus
on approaches to this new world, the faster we may achieve the goal of
a fully empowered and connected electronic information system designed
with the patient in mind.
At the global level, NQF launched a series of activities designed
to promote shared understanding among those involved in advancing
electronic measurement and data infrastructure. It convened the
eMeasure Learning Collaborative, a new environment for promoting best
practices related to development and implementation of measures applied
to electronic data sources (i.e., eMeasures). eMeasures are an
innovation in advancing quality measurement, but significant barriers
hamper their wider scale creation, adoption, and use. Through two in-
person meetings and other virtual convenings, NQF brought together
hundreds of stakeholders including government representatives, EHR
vendors, measure developers, clinicians, and hospitals--creating a
unique forum for these parties to work together on new eMeasurement
approaches.
Specific eMeasure best practices emerged from this Learning
Collaborative, particularly in three areas: Organizational leadership,
data representation and clinical workflow, and learning health systems.
For example, regarding data representation, all participants identified
the need for measure developers and other stakeholders to communicate
earlier in the eMeasurement process, particularly when measure
developers are selecting data and representing data in eMeasure logic.
For this best practice to become a reality, a national structure and
process must exist to enable this level of dialogue. With respect to
organizational leadership, participants suggested that provider
organizations create inter-professional, physician-led teams focused on
an integrated approach to eMeasure adoption, including data capture,
reporting, workflow, clinical decision support, and evidence-based
practice.
Several of NQF's 2012 projects sought to facilitate a unified
understanding of terms and measurement approaches used in the health IT
field, so that measure developers and implementers, health IT vendors,
standards organizations, and other users of eMeasures and tools work
with a similar lexicon. For example, NQF launched the Health IT
Knowledge Base, providing answers to some of the most common technical
questions about NQF's related initiatives. Since August 2012, NQF added
more than 70 new entries to the frequently asked questions section,
stemming from its interactions with
[[Page 46706]]
eMeasure users and developers. NQF also added a glossary with more than
150 terms and definitions. As a complement to the Knowledge Base, NQF
provided opportunities for stakeholders to learn about best practices
in eMeasurement through a series of NQF-hosted health IT webinars that
reached more than 1,400 people during the past 12 months.
As quality measurement shifts to an electronic platform, additional
clarity is needed regarding the testing that assures that eMeasures can
be used for a range of accountability applications, which require both
precision and reliable and valid results. NQF worked with CMS and the
Office of the National Coordinator for Health Information Technology
(ONC) to ensure that the data capture for eMeasures is feasible without
impeding clinical workflow. NQF's health IT initiatives in 2012 scaled
down to the granular level as well, to help standardize the efforts of
the creators and users of eMeasures. Developed by NQF, the Quality Data
Model (QDM) is an ``information model'' that defines concepts used in
quality measures and clinical care in a way that allows the information
to be collected automatically from data already stored in an EHR.
An example illustrates how the QDM can simplify and standardize the
electronic collection and reporting of quality measures. If a
physician's office wants to use its EHR to report on a measure that
assesses the percentage of patients with a diagnosis of coronary artery
disease (CAD) who were prescribed a lipid-lowering therapy, the EHR
must first identify the patients with CAD within the physician's
practice and then determine whether the patients had the therapy. If
the physician's performance is going to be compared to her peers, then
her EHR must define these elements in exactly the same way as every
other EHR. The QDM supports this type of query regardless of the type
of EHR by defining the necessary standard data elements (e.g., active
diagnosis, active medication administered/ordered/dispensed) and the
type of coding that the EHR may use to express the result (e.g., ICD-9
code for diagnosis; RxNorm for medication, etc.). When all measure
specifications are written in a common way, EHR vendors can more easily
ensure that their EHRs can support quality measurement, and the
validity of electronic-based reporting programs will likely increase.
NQF released an updated version of the QDM in December 2012, which
focused on simplifying and standardizing QDM measure logic to support
implementation of the federal Meaningful Use regulations. NQF also
regularly receives ongoing feedback and insights into best practices
from a User Group of measure developers, physicians, hospitals, and EHR
vendors who are currently actively involved in eMeasure use.
NQF's work in standardizing eMeasurement extends to measure
development. NQF partnered with a software developer to develop the
Measure Authoring Tool (MAT), which is a publicly available, free, web-
based tool designed to allow measure developers to create eMeasures
using the aforementioned QDM, without needing to write programming
code. At the end of 2012, NQF prepared to transition the day-to-day
operation of the MAT to HHS, giving HHS the opportunity to better
position the MAT and eMeasures in federal programs using EHR-based
performance measurement, and to support the MAT's evolution.
Also in 2012, NQF completed the Critical Paths for Creating Data
Platforms project. This effort helped assess the readiness of
electronic data to support innovative measurement concepts and
recommended steps to address data and infrastructure gaps and barriers
in two high-priority domains: care coordination and patient safety. The
care coordination report focused on transitions of care and
communication of the patient plan of care. The patient safety report
focused on effective use of infusion devices (e.g., giving medication
through an IV) in acute care settings. The ability to capture data
across settings is fundamental to gauging, for example, the degree of
care coordination in a healthcare system. The final reports from these
projects delineated specific steps that the government and private
sector can take to enable electronic measurement in these areas.
Deliverables Associated With These Activities
----------------------------------------------------------------------------------------------------------------
Status (as of 1/7/ Notes/Scheduled or actual
Description Output 2013) completion date
----------------------------------------------------------------------------------------------------------------
Surgery measures and maintenance Two-phase project to Completed............ Phase 1: 18 measures
review. endorse new surgery endorsed in December
measures and conduct 2011.
maintenance on existing NQF Board endorsed 24
NQF-endorsed measures. measures in Phase 2 in
January 2012.
Phase 2 addendum endorsed
9 measures in May 2012.
51 endorsed measures
total, 42 maintenance.
Efficiency and resource-use Endorsed measures of Completed............ Imaging Efficiency
measures. imaging efficiency; white (Complete)
paper drafted; endorsed --6 imaging efficiency
measures of healthcare measures endorsed in
efficiency. February 2011.
--1 imaging efficiency
measure was recommended
to be combined with an
existing NQF measure and
was endorsed in April
2011.
Efficiency--Resource Use
(In Progress).
Cycle 1: 4 measures
endorsed in January 2012.
Cycle 2: 4 measures
endorsed in April 2012.
--8 total measures
endorsed, zero
maintenance.
Cancer measures and maintenance Project to endorse new Completed............ Phase 1: 22 measures
review. cancer measures and endorsed October 2012,
conduct maintenance on 18 maintenance.
existing NQF-endorsed Phase 2: 16 measures
measures. endorsed in October
2012, 10 maintenance
[[Page 46707]]
Perinatal measures and maintenance Project to endorse new Completed............ 14 perinatal measures
review. perinatal measures and endorsed April 2012, 12
conduct maintenance on maintenance.
existing NQF-endorsed
measures.
Renal measures and maintenance Project to endorse new Completed............ 12 renal measures
review. renal measures and endorsed April 2012,
conduct maintenance on nine maintenance.
existing NQF-endorsed
measures.
Pulmonary/critical-care measures Project to endorse new In progress.......... 19 pulmonary/critical-
and maintenance review. pulmonary/critical-care care measures endorsed
measures, and conduct July 2012, 16
maintenance on existing maintenance. One
NQF-endorsed measures. additional measure
endorsed in January
2013, with two final
measures still under
review.
Palliative and end-of-life care... Project to endorse new Completed............ 14 palliative and end-of-
palliative and end-of- life care measures
life care measures and endorsed February 2012,
conduct maintenance on 2 maintenance.
existing NQF-endorsed
measures.
Care-coordination measures and Set of endorsed care- Completed............ 12 care coordination
maintenance review. coordination measures. measures endorsed August
2012, 12 maintenance.
Population Health Phase 1: Set of endorsed measures Completed............ 19 population health
Prevention measures and for preventative services. measures endorsed May
maintenance measures review. 2012, 17 maintenance.
Population health Phase 2: Commissioned paper Completed............ Five measures also
Population health measures. addressing population endorsed in October
health measurement issues 2012, 3 maintenance.
and set of endorsed
population health
measures, plus set of
endorsed measures.
Behavioral health measures and Set of endorsed measures Phase 1 completed, Phase 1 endorsed 10
maintenance review. for behavioral health. phase 2 slated for measures in October
2013. 2012, 4 maintenance.
All-cause readmissions (expedited Set of endorsed all-cause Completed............ 2 all-cause readmissions
Consensus Development Process readmission measures. measures endorsed June
[CDP] review). 2012, zero maintenance.
Multiple Chronic Conditions Work plan completed; Completed............ May 2012.
Measurement Framework report interim report available
analyzing measures being used to for public comment.
gauge quality of care for people
with multiple chronic conditions.
Patient-reported outcomes (PROs) Two workshops discussing Completed............ Final report completed
workshops addressing commissioned papers December 2012.
prerequisites for endorsed PRO addressing methodological
measures. prerequisites for NQF
consideration of PRO
measures for endorsement.
Oral health....................... Report that catalogs oral Completed............ July 2012.
health measures, measure
concepts, priorities and
gaps in measurement.
Rapid-cycle CDP improvement Summary of process Completed............ May 2012.
(measure-endorsement process). improvement approach,
events, and metrics used
to enhance the quality
and efficiency of CDP
process.
GI/GU Two-Stage CDP............... Proposed two-stage pilot Stage 1 completed.... 12 measure concepts
project designed to approved in December
provide early guidance to 2012.
measure developers on
whether a measure concept
meets NQF's criterion for
importance to measure and
report before they invest
time and resources in
specifying and testing a
measure.
Patient-safety-complications Set of endorsed measures Completed............ 14 measures endorsed June
measures and maintenance review on complications-related 2012, 14 maintenance.
(Phase 1). areas. 2 additional measures
endorsed August 2012, 2
maintenance.
16 measures total, 16
maintenance.
Infectious disease measures and Set of endorsed infectious In progress.......... 14 measures endorsed
maintenance review. disease measures. January 2013, 10
maintenance. Two
measures still under
review.
[[Page 46708]]
Regionalized Emergency Medical Provide guidance for Completed............ .........................
Care Services measure topic measure development to
prioritization. ASPR's prioritized areas
of (1) ED crowding,
including a specific
focus on boarding and
diversion, (2) emergency
preparedness, and (3)
surge capacity.
Registry Needs Assessment......... Hosted a public workshop Completed............ .........................
that discussed measure
information needs,
requirements, and
potential approaches to
measure information
management, as well as 2
webinars--focused on
measure information
management systems and a
discussion on major
findings of the workshop,
respectively. Final
report summarized major
findings and included
public feedback.
Common formats for patient safety Responsible--on behalf of Completed............ .........................
data. AHRQ--for coordinating a
process to obtain
comments from
stakeholders about the
Common Formats authorized
by the Patient Safety and
Quality Improvement Act
of 2005.
QDM maintenance................... Updated the QDM to Updates to QDM are Each new version of the
incorporate additional ongoing with input QDM will be published as
types of measurement data from NQF members, needed. NQF will post a
needed to support the QDM User Group draft of modifications
emerging measures. The and other interested for each version.
QDM June 2012 Update was stakeholders..
released in summer for
public comment.
The QDM December 2012 was
released in December
based on feedback from
the 2014 Clinical Quality
Measure (CQM) development
cycle for Meaningful Use
Stage 2.
MAT............................... Non-proprietary, web-based Completed............ CMS assumed day-to-day
tool that allows responsibilities of the
performance-measure MAT as of January 2013.
developers to specify,
submit, and maintain
electronic measures in a
more streamlined,
efficient, and highly
structured way.
Refinement of the eMeasure Process Provided education and Ongoing.............. Launched and maintained
and Technical Assistance. outreach to both HHS and the Health IT Knowledge
its contractors, and to Base which includes
the users of QDM, frequently asked
eMeasures, and the questions (FAQs) from
Measure Authoring Tool: webinars, technical
measure developers, EHR assistance log, user
vendors, and providers feedback, etc., a
implementing measures. glossary of terms and
This education and links to Health IT
outreach included both reports.
interactive teaching Updated and maintained
through webinars and live the Measure Authoring
presentations, as well as Tool (MAT) User Guide.
development of technical Provided technical
information posted on assistance to HHS/ONC/
NQF's Web site. Technical CMS eMeasure contractors
support was also provided focusing on topics such
to HHS/CMS/ONC as needed. as QDM and eMeasure
logic in preparation for
the release of MU2.
Participated in eMeasure
support calls and
meeting as requested by
ONC and CMS.
Completed 6 public
webinars with over 1850
total attendees,
focusing on the Measure
Authoring Tool (MAT),
Quality Data Model (QDM)
and eMeasures.
Commissioned paper on data sources Final report and Completed............ April 2012.
and readiness of HIT systems to commissioned paper.
support care coordination.
Critical Paths.................... Examine new measurement Completed............ Patient Safety and Care
areas (e.g. care plans) Coordination final
to understand the reports completed in
feasibility of measuring October and November
such areas in an 2012.
electronic environment.
eMeasure Learning Collaborative... Examining issues related Completed............ Final report completed in
to implementation of December 2012.
eMeasures with a multi-
stakeholder group in
order to define best
practices and
recommendations to the
Office of the National
Coordinator's Federal
Advisory Committees.
eMeasure feasibility testing...... Review the current state In progress.......... Draft guidance report
of feasibility assessment will be finalized and
for eMeasures and released for public
identify a set of comment. Slated for
principles, completed by 4/5/13.
recommendations, and
criteria for adequate
feasibility assessment.
[[Page 46709]]
Composite evaluation guidance..... Reassess NQF's existing In progress.......... Final report slated for
guidance for evaluating completed by 4/5/13.
composites, with
particular consideration
of recent changes in
composite measure
development and related
methodology.
----------------------------------------------------------------------------------------------------------------
4. Aligning Measure Use To Enhance Value
Under section 1890(b)(5)(A)(i) of the Social Security Act, the
entity is required to provide a description of its implementation of
quality and efficiency measurement initiatives under the Social
Security Act and the coordination of those initiatives with those
implemented by other payers.
Under section 1890A of the Social Security Act, HHS is required to
establish a pre-rulemaking process under which a consensus-based entity
(currently NQF) would convene multi-stakeholder groups to provide input
to the Secretary on the selection of quality and efficiency measures
for use in federal programs as specified under section 1890(b)(7)(B) of
the Social Security Act. The list of quality and efficiency measures
HHS is considering for selection will be publicly published no later
than December 1 of each year. No later than February 1 of each year,
NQF will report the input of the multi-stakeholder groups which will be
considered by HHS in the selection of quality and efficiency measures
for use in federal programs as specified under section 1890(b)(7)(B) of
the Social Security Act.
Alignment with respect to use of the same performance measures is a
critical strategy for accelerating improvement, reducing wasteful
reporting burden, and enhancing transparency in healthcare. The NQF-
convened Measure Applications Partnership (MAP), launched in the spring
of 2011 as mandated by the Patient Protection and Affordable Care Act
(Pub. L. 111-148, section 3014), is a key facilitator of measure
alignment across federal programs and between the public and private
sectors. The input that the MAP provides to HHS for purposes of the
pre-rulemaking process and national priorities under the National
Quality Strategy results from multiple stakeholders composed of
representatives from more than 60 major private-sector stakeholder
organizations, 10 federal agencies, and 40 individual technical experts
MAP's input enhances HHS's ability to coordinate its quality and
efficiency measurement initiatives with those initiatives implemented
by other payers.
More specifically, MAP provides a forum for annual multi-
stakeholder input into which performance measures are used in federal
public reporting and pay-for-performance programs in advance of related
regulations being issued. This approach augments traditional
rulemaking, allowing the opportunity for substantive dialogue with HHS
before rules are issued, a chance for alignment across programs with
respect to use of measures, and consideration of longer term
implications. MAP also provides a unique forum for public- and private-
sector leaders to develop and then broadly vet a future-focused
performance measurement strategy (outlined in the MAP strategic plan
below), as well as the shorter term recommendations for that strategy
on an annual basis in pre-rulemaking reports. MAP strives to offer
recommendations that are cross-cutting and coordinated across: settings
of care; federal, state, and private programs; levels of measurement
analysis; payer type; and points in time.
Published on February 1, 2012, MAP's first pre-rulemaking report
offered recommendations related to 17 federal programs.\25\ This
report:
Recommended that 40 percent of the measures that CMS
proposed at the end of 2011 move into federal programs targeting
clinicians, hospitals, and post-acute care/long-term care (PAC/LTC)
settings via rules issued in 2012, with another 15 percent targeted for
future consideration after further development, testing, and
feasibility issues are worked out. MAP did not support inclusion of the
remaining 45 percent primarily because many of the measures did not
have enough information, specificity, testing, or proof of
implementation feasibility to guide MAP measure evaluation and
selection. See Appendix C for the criteria MAP used to guide measure
selection.
Expressed clear preference for both using NQF-endorsed
measures and for developing more robust feedback loops. Over 90 percent
of the measures that MAP supported for inclusion in the first round of
pre-rulemaking input were currently NQF-endorsed, with the remainder
likely eligible for expedited review. In addition to these criteria,
NQF is establishing more robust feedback loops that can help HHS, MAP,
and the broader field to discern which of the endorsed measures are
best suited for inclusion in future reporting and value-based
purchasing programs. More specifically, in 2012 MAP analyzed what
internal and external sources exist to obtain feedback from end users
and informally engaged MAP members to understand how they would
prioritize varying types of feedback information.\26\
Considered how to further align measures across public
programs and with the private sector with the goal of more targeted,
inter-related sets of measures that are reported by different kinds of
providers, in different settings, and across time.
Laid out guiding principles for a three- to five-year
measurement strategy where priority is placed on: (1) Measures that
drive the system toward meeting the NQS; (2) measures that are person-
rather than clinician-focused; and (3) measures that span settings,
time, and types of clinicians. Person-centered measurement provides
information about what matters to patients (e.g., ``Will I be able to
run after I recover from knee surgery?'') and that is specific to
patient populations or care over time, (e.g., ``Did I get the care and
support needed to manage my diabetes so that I did not lose my vision
or my mobility?''). This kind of measurement is predicated on a
redesigned delivery and payment system and an HIT-enabled environment
that facilitates both coordination and integration of care for a range
of patients across the continuum.
Federal Medicare and Meaningful Use rules issued over the course of
2012 largely followed the MAP pre-rulemaking recommendations for
inclusion or exclusion of measures in over 20 different payment and
reporting programs that MAP was asked to consider. However, concordance
between the HHS final rules issued in 2012 with the MAP 2012
recommendations varied depending on the program (see table below for
key
[[Page 46710]]
programs). Over 70% concordance was observed for the majority of
relevant programs. Of the two programs that had lower concordance with
MAP Recommendations, there were only five measures in one program (ESRD
QIP) relevant to the analysis, and there was a relatively short time
period available for HHS to consider MAP's input for the other program
(Meaningful Use). There were various reasons for the individual
instances of discordance. Where CMS did not finalize measures that MAP
supported, the most common issue was difficulty of data collection or
other burden imposed by those measures. Excluded from the concordance
analysis were many measures that had not yet been reviewed or endorsed
by NQF at the time of MAP's evaluation, leaving MAP with insufficient
information to provide a definitive ``Support'' or ``Do Not Support''
recommendation. For example, in the Medicare Physician Fee Schedule
rule, CMS included a number of non-endorsed measures that address the
broad array of medical specialties to engage more physicians in federal
physician-level programs. Going forward NQF is poised to quickly move
these measures through review for potential endorsement.
Concordance of MAP ``Support'' and ``Do Not Support'' Recommendations
With Measures Included in Selected HHS Programs From HHS Final Rules
Issued in 2012
------------------------------------------------------------------------
Concordance of
MAP
Recommendations
HHS Final Rules With HHS Rules
Issued in 2012
(percent)
------------------------------------------------------------------------
Hospital IQR......................................... 73
Hospital VBP......................................... 71
Inpatient Psych Facility............................. 100
Meaningful Use....................................... 50
Physician Quality Reporting System (PQRS)............ 79
End-Stage Renal Disease Quality Improvement Program 40
(ESRD QIP)..........................................
------------------------------------------------------------------------
MAP Strategic Plan for Measurement. To spur progress toward a
defined set of goals and priorities related to the NQS--which include
improved quality and safety, more transparency, and enhanced value--MAP
developed a three-year strategic plan for measurement (2012-2015). This
plan was released on October 1, 2012, and is intended to inform HHS's
future measure development planning, as well as shape annual rulemaking
advice in the years ahead. The plan has the following three major
components:
Define sets of measures as families of measures with the
objective of knitting together related measures currently found in
different programs, care settings, levels of analysis, and populations.
This approach complements the program-specific recommendations that MAP
made in its pre-rulemaking report. Individual measures are carefully
selected to work together as a ``family'' to drive the overall system
toward better performance in a given area, promote more patient-
centeredness, and decrease reporting burden for providers. Families of
measures are linked to a high-impact condition (e.g., diabetes) or an
NQS priority (e.g., safety) and are intended to promote further measure
alignment by specifying within the families more discrete core measure
sets focused on hospitals, clinicians, or post-acute/long-term care.
See MAP's Families of Measures report or for a summary of the report,
see page 28.
Engage stakeholders that develop, report, and use measures
to glean feedback about the use and usefulness of measures. The idea is
to create more effective two-way communication so that the experiences
of end users directly inform MAP's recommendations to HHS, contribute
to the thinking of the diverse stakeholders that participate directly
and indirectly in MAP's activities, as well as inform the work of
measure developers as they address identified measurement gaps in a
more coordinated fashion.
Develop analytic support for MAP decision making. The goal
is to further enrich MAP's thinking and decision-making by integrating
important data and information that are developed across NQF as a
strategic byproduct of its different activities. These include input to
priority setting and strategies, measurement review and endorsement,
and advice on measure selection. This function would also draw upon the
various outside efforts under way to glean information about measure
use and impact. The analysis and integration of internal and external
data will inform and likely refine MAP's overall selection criteria, as
well as its recommendations to HHS in future pre-rulemaking reports. In
addition, an independent third-party evaluation is planned to determine
whether MAP is meeting its overall objectives.
The MAP pre-rulemaking recommendations and strategic plan largely
reflect the current reality of our siloed healthcare payment and
delivery systems, but anticipate a future system with shared
accountability for patient welfare, community health, and stewardship
of scarce resources.
Families of Measures
MAP selected safety, care coordination, cardiovascular conditions,
and diabetes as its first focus areas for identification of families of
measures-- all areas called out in the NQS and/or leading causes of
mortality. MAP's first families of measures report was published on
October 1, 2012.
MAP reviewed 676 measures across these 4 topics, using criteria
laid out in the report as a guide to inform selection. Of these
measures, MAP recommended 55 safety, 60 care coordination, 37
cardiovascular, and 13 diabetes measures for inclusion in 4 distinct
families of measures. MAP further defined more discrete core measures,
which include available measures, and gaps specific to a care setting
(e.g. hospitals, post-acute care/long-term care), level of analysis
(e.g. individual clinicians), or population drawn from each family of
measures and made program-specific recommendations in its 2013 pre-
rulemaking report. MAP anticipates identifying families of measures for
patient and family engagement, population health, affordability/cost,
and mental health in 2013, pending funding decisions.
MAP defined families of measures with the intent that their
implementation would lead to performance improvement and further
cohesion and synergy of care in a targeted area. Measures in a given
family bridge healthcare settings, types of providers, and time and are
interconnected in the way patients would ideally like to experience
care. Families of measures also include identifying measure gaps, which
strongly signal to developers where new measures are needed, and can
help facilitate prioritization of funding for measure development.
For example, the safety family of measures contains 9 topic areas
and 22 subtopic areas. The topic areas include but are not limited to
reducing healthcare-acquired infections and obstetrical adverse events
and increasing procedural safety. Examples of specific gaps in the
safety family of measures include post-discharge follow-up of
infections in ambulatory settings, ventilator-associated events with
special considerations for the pediatric population, and infection
measures reported as rates rather than ratios, which would be more
meaningful to consumers. The 55 measures selected for the safety family
of measures follow themes such as creating a culture of safety, patient
and caregiver
[[Page 46711]]
engagement, reporting meaningful safety information, and cost of care
implications. These measures were selected for their ability to cross
settings to simultaneously affect patients, caregivers, and purchasers
and to ultimately increase safety for all patients.
Measure Use and Alignment
Although the advantages of measure alignment are many, few studies
have systematically examined this phenomenon. A 2011 RAND study of 75
diverse organizations found that nearly all used NQF-endorsed measures,
although there was considerable variability in which measures were used
and for what purposes. Most used NQF-endorsed measures in quality
improvement programs, followed closely by use in public reporting and
then payment programs. The 2011 study also found that the organizations
surveyed indicated a strong preference for NQF-endorsed measures where
they exist because they are vetted, evidence-based, and known to be
more credible with providers.\27\
In 2011 and 2012, NQF conducted initial research outside of the HHS
contract to better understand which organizations are using NQF-
endorsed measures and where there is alignment across sectors with
respect to that use.28 29 In addition, NQF is developing
more systematic approaches to capturing detailed feedback from end
users about the usefulness of NQF measures in driving improvements in
health and healthcare.
The 2012 analysis showed that 86 percent of the 706 NQF-endorsed
measures were in use, with the balance of the portfolio not in use
largely consisting of measures recently endorsed (last 1-3 years) and
expected to be used in the near future. Federal use of the NQF
portfolio was stable at about 50 percent. Private payer use of the NQF
portfolio grew from 21 percent to 35 percent during this period; state
use grew from 21 percent to 23 percent. Much of the increase in private
payer use is likely attributable to better data collection by NQF,
rather than increased use of NQF-endorsed measures by private payers.
The federal government, private plans, and states appear to be
increasingly using the same NQF-endorsed measures. In 2012, the federal
government and private payers used the same 76 measures in
accountability programs, or 13 percent of the 606 NQF-endorsed measures
in use. During the same period, federal and state alignment was 48
measures, or 8 percent, and private payer and state alignment was 51
measures, or 8 percent. In 2012, 25 measures were simultaneously used
by the federal government, private payers, and states. When all users
are taken into account (including local communities, registries and
others users), about 29 percent of the NQF-endorsed portfolio was used
by two or more stakeholders in 2012.
NQF Facilitates National, State, and Local Measure Alignment
Improvement Targets: Inform the National Quality Strategy
(National Priorities Partnership)
Measures: Endorse and harmonize measures
Incentives: Advise HHS on reporting/payment programs (Measure
Applications Partnership)
National-Local Actions: Develop tools to align use of measures
(Quality Positioning System or QPS) and efforts of national/local
organizations implementing strategies at the delivery system level
(National Priorities Partnership)
Alignment at the Community Level
Given the number and diversity of community-based efforts, it is
challenging to get a comprehensive sense of how standardized measures
are being used at the local, state, or regional levels. That said, the
number of regional multi-stakeholder collaboratives or alliances that
are collecting, reporting, and in some cases paying on the basis of
performance measures appears to have grown over the past number of
years. As of October 2012, the Robert Wood Johnson Foundation has
cataloged on its Web site a compendium of nearly 260 state, local, or
regional efforts to publicly report on healthcare performance across
the United States.\30\
To better understand the public-reporting activities in a subset of
these community-based groups, NQF analyzed the measure use of 16
alliances that receive funding from the Robert Wood Johnson Foundation
through the Aligning Forces for Quality (AF4Q) program. This analysis
showed that these alliances are using 171 NQF-endorsed measures in
their reports to the public, and it provided insight to NQF as to the
kinds of tools and capabilities communities are seeking as they evolve
measurement efforts on the local level.
Supported by the Robert Wood Johnson Foundation, NQF has developed
tools outside of the HHS contracts to support local, state, and
regional leaders interested in using NQF-endorsed measures,
particularly those measures also used in federal programs. For example,
NQF's publicly available Quality Positioning System (QPS) enables users
to search a database of NQF-endorsed measures and to build a portfolio
or custom list of NQF-endorsed measures that they use or in which they
are interested. A QPS user can then compare that portfolio against
measures used in federal and other national programs, aligning
measurement efforts where it makes sense to do so. A QPS user also can
share its portfolio with others by self-publishing it within QPS on the
NQF Web site. This feature and the ability to discern which NQF-
endorsed measures are being used in federal programs can provide a rich
information base to help communities, states, and the federal
government synchronize their approaches to measuring and improving
quality.
Deliverables Associated With These Activities
----------------------------------------------------------------------------------------------------------------
Notes/scheduled or
Description Output Status (as of 1/7/2013) actual completion date
----------------------------------------------------------------------------------------------------------------
Measures for use in quality reporting Measure Applications Completed.............. February 2012.
programs under Medicare. Partnership Pre-
Rulemaking Report:
Input on Measures
Under Consideration by
HHS for 2012
Rulemaking.
MAP report recommending measures that Final report including Completed.............. June 1, 2012.
address the quality issues potential new
identified for dual-eligible performance measures
beneficiaries. to fill gaps in
measurement for dual-
eligible beneficiaries.
[[Page 46712]]
MAP report recommending measures for Final report including Completed.............. June 1, 2012.
use in quality reporting for MAP Coordinating
Prospective Payment System-exempt Committee
cancer hospitals. recommendations.
MAP report recommending measures for Final report including Completed.............. June 1, 2012.
use in quality reporting for hospice MAP Coordinating
care. Committee
recommendations.
MAP Strategic Plan 2012-2015......... Final report........... Completed.............. October 2012.
MAP report detailing families of Final report........... Completed.............. October 2012.
measures for safety, care
coordination, cardiovascular
conditions, and diabetes.
----------------------------------------------------------------------------------------------------------------
5. Identifying Measure Gaps and Developing Strategies for Filling Them
Under section 1890(b)(5)(iv) of the Social Security Act, the entity
is required to describe gaps in endorsed quality and efficiency
measures, including measures within priority areas identified by HHS
under the agency's National Quality Strategy, and where quality and
efficiency measures are unavailable or inadequate to identify or
address such gaps. Under section 1890(b)(5)(v) of the Social Security
Act, NQF is also required to describe areas in which evidence is
insufficient to support endorsement of quality and efficiency measures
in priority areas identified by the National Quality Strategy and where
targeted research may address such gaps.
Performance measurement science has made important strides in the
last decade, including addressing new settings and types of providers,
becoming more responsive to the needs and preferences of varied
stakeholders, evolving with new technology, and increasingly addressing
hard-to-measure concepts such as care coordination and appropriateness.
Despite these gains, measurement gaps persist, either because the
measures have not yet been developed, or the measures exist but are not
being used.
To identify measurement gaps, NQF conducted an extensive analysis
in 2012 of its current measures portfolio against both the National
Quality Strategy priority areas and high-impact conditions (both
Medicare and child health) as required by statute (Social Security Act,
section 1890(b)(5)(iv)), analyzed stakeholder feedback, and considered
which NQF-endorsed measures were being used and by which sector. The
gaps identified below, however, do need to be viewed in the context of
rising concern about measurement overload and administrative burden.
While more measures are needed to address high-priority issues, NQF
continues to remove measures that no longer meet its criteria or where
performance ``tops out'' to ensure measurement parsimony.
Synthesis of Measure Gaps
Captured in the 2012 NQF Measure Gap Analysis, this report revealed
that discussions of measure gaps too often remain at a high conceptual
level, and that more detailed information is needed to inform next
steps, whether those steps entail measure development or addressing
barriers to implementation of existing measures. In addition, while
there may be non-NQF endorsed measures currently in use that address
high-priority gap areas, a full assessment of their applicability and
appropriateness was beyond the scope of this project. Such measures
should be brought forth for NQF endorsement to assess their importance,
scientific reliability and validity, usability, and feasibility before
an assessment of value or recommendations for use can be made. The
following are high-level syntheses of the measure gaps identified
through the NQF analysis, presented through the lens of the three aims
of the NQS.
Better Care
The lion's share of current NQF-endorsed measures related to better
care focused on specific conditions. Addressing the gaps identified
below would provide added input directly from patients about their care
and could further focus the healthcare system on the needs and
preferences of patients and families, including the most vulnerable
patients.
Patient-reported outcomes (PROs)--To fully assess the quality and
safety of healthcare, the gap analysis emphasized the importance of
patient-reported outcomes--any report of the patient's health status
that comes directly from the patient, without interpretation by a
clinician or anyone else. Domains for measurement include symptoms and
symptom burden, health-related quality of life including functional
status, experience with care, and health-related behaviors. Especially
important are PRO-based performance measures that can be aggregated
accurately and reliably to the level of an accountable healthcare
entity, and that span the full continuum of care.
Patient-centered care and shared decision-making--To spur the
healthcare system to be more responsive to patients and families,
measures are needed that assess whether patient and family treatment
preferences are identified; whether their psychosocial, cultural,
spiritual, or healthcare literacy needs are addressed; whether they are
actively engaged in developing a care plan; and whether their expressed
preferences and goals for care are met. Measures of decision quality
are critical for assessing whether patients understand evidence-based
treatment options and whether they are able to make decisions based on
information provided by their healthcare practitioner.
Care coordination and care transitions--Important outcome measures
are needed to assess whether patients, families, and caregivers believe
that the overall care coordination process--including the quality of
communication, care planning, care transitions, and team-based care--
satisfactorily prepared them to manage their care and return to the
best possible quality of life. The timeliness of access to high-quality
palliative care or hospice services, including pain and symptom
management, psychosocial support, and advance care planning also is
identified as a gap area in need of further attention. Measure gaps
related to effective medication management and patient adherence, and
adverse drug events remain.
[[Page 46713]]
Care for vulnerable populations--A critical gap area to be filled
includes the ability to measure whether high-quality care is available
to patients most in need, particularly the vulnerable elderly,
individuals with multiple chronic conditions and complex care needs,
critically ill patients, patients receiving end-of-life care, children
with special needs, residents in long-term care settings, the homeless,
and people who are dually eligible for Medicare and Medicaid.
Healthy People/Healthy Communities
Recognizing that the health of the American public is mostly
attributable to healthy life style behaviors, environment, or social
status, the following gap areas push the field beyond the traditional
boundaries of the healthcare delivery system and offer the potential
for dramatic gains in health for the nation.
Health and well-being--Measures within and outside of the
healthcare system are needed to assess health-related quality of life
and to optimize the population's well-being. Measures that assess the
burden of illness experienced by patients, families, and caregivers, as
well as measures of productivity also are important. Community indices
that measure key factors or social determinants known to significantly
influence health or drive unnecessary utilization of healthcare
services are needed to develop community programs that effectively and
appropriately target resources and interventions to improve population
health and reduce disparities.
Preventive care--Composite measures of the highest impact age- and
sex-appropriate clinical preventive services, particularly for the
cardiovascular disease priority area, continue to be important measure
gaps to fill. Oral health was highlighted as an important area in need
of measures, specifically for the prevention of dental caries, as were
coordination of long-term support services and psychosocial, behavioral
health, spiritual, and cultural services. An emerging area of focus for
measurement is on the extent to which care is coordinated beyond the
healthcare delivery system--particularly between healthcare, public
health, and community support services--and how individual
organizations are held collectively accountable.
Childhood measures--Measure gaps for child and adolescent health
emphasized the attainment of developmental milestones, the quality of
adolescent well-care visits, prevention of accidents and injuries, and
prevention of risky behaviors. There also is a heightened need for
measures of childhood obesity in addition to body mass index for more
effective upstream management, given the risk for development of
diabetes, cardiovascular disease, and other chronic conditions.
Accessible and Affordable Care
Affordability is often narrowly construed. The following
identification of gaps broadens its definition so that affordability is
viewed through a variety of lenses including the individual and
society, for example, out-of-pocket costs to patients and families and
costs to the healthcare system. Further, a commitment to ensuring
access to affordable, high quality care for all necessitates judicious
use of resources at the individual level.
Access to care--In addition to measures that assess insurance
coverage, the analysis revealed that measure gaps indicative of access
to needed care are important to address. Important considerations
include the ability to obtain medications, mental health, oral health,
and specialty services in a timely fashion. Measures also are needed to
assess disparities in access and affordability, particularly with
regard to socioeconomic status, race, and ethnicity, and for vulnerable
populations.
Healthcare affordability--Many stakeholders emphasize the need for
affordability indices that reflect the burden of healthcare costs on
consumers and that include direct costs (e.g., out-of-pocket expenses,
personal healthcare expenditures per capita) as well as indirect
opportunity costs (e.g., productivity, work and school absenteeism, and
the ``cost of neglect'' of medical and dental care). Efficiency
measures are needed to benchmark providers on cost and quality as well
as to quantify the impact of inefficiencies across care settings to
further target quality improvement efforts. Purchasers and consumers
continue to emphasize the importance of understanding pricing and
improved transparency of data through standardized measurement and
reporting.
Waste and overuse--Measures that assess the extent to which the
healthcare system promotes the provision of medical, surgical, and
diagnostic services that offer little if any value--and that may be
harmful to patients--are critical to closing gaps in variation.
Specific areas frequently cited as important for measurement include
appropriate, patient-centered and patient-directed end-of-life care;
unnecessary emergency department visits and hospital admissions and
readmissions (particularly for ambulatory-sensitive conditions);
inappropriate medication use and polypharmacy; and duplication of or
inappropriate services and testing, particularly imaging.
Availability of NQF-endorsed Measures
Although the NQF portfolio increasingly maps to the NQS, its extent
varies across each of the six NQS priorities. For example, 40 percent
of NQF measures that map to the NQS at the goal level address patient
safety, including a wide range of measures related to healthcare-
acquired conditions and hospital readmissions. Yet only 7 percent of
measures that map at the goal level address patient and family
engagement, with very few measures to address important areas of shared
decision making, patient navigation, and patient self-management.
Likewise, measures to address healthy lifestyle behaviors and community
interventions to prevent cardiovascular disease upstream also warrant
increased attention. Specific measures of cost remain a high-priority
gap area, particularly for purchasers of healthcare.
NQF's portfolio includes more than 400 condition-specific measures,
more than 250 of which address the high-impact Medicare conditions. Yet
only 53 of the measures address the specific high-impact child health
conditions, and 12 of the high-impact child health conditions do not
have any specific endorsed measures. While the lack of measures for
certain conditions may be of interest or concern, future measure
development should be prioritized to focus on cross-cutting measures
that apply to patients regardless of their disease process.
NQF Measure Portfolio in Use
The federal government remains the predominant user of NQF-endorsed
measures, but a growing number of measures are in use across other
public-sector programs--including state and local programs--as well as
in the private sector. More promising is the emerging overlap in
measure use across these sectors. Further alignment--or use of the same
measures--offers the potential to significantly reduce measurement
burden and to simultaneously accelerate improvement by sending
consistent signals about what is important for providers to focus care
improvement resources against.
Overall, 64 measures in the NQF portfolio that address specific NQS
goals are in concurrent use in federal programs and two or more private
programs. While the majority of these are safety-related measures, a
small
[[Page 46714]]
number address aspects of overuse, patient experience, and preventive
screenings. A nearly equal number of measures that address specific NQS
goals are not in use in any of the programs analyzed--a missed
opportunity, particularly for goals related to function and quality of
life, hospice and palliative care, mental health, and preventive
services for children. Similarly, the analysis revealed that 57
measures in the NQF portfolio that address high-impact conditions are
in concurrent use in federal programs and two or more private programs,
the majority of which reflect the high-impact Medicare conditions.
However, 47 measures that address high-impact Medicare or child health
conditions had no identified use in any of the sectors analyzed.
Consideration should be given to the potential barriers that prevent
these measures from being implemented in the field.
The Path Forward
As the field--the public and private stakeholders committed to
building a solid foundation for quality improvement--strives to
continually advance the use of standardized performance measurement,
there is a strong desire to accelerate efforts to fill, rather than
just identify, key measurement gaps. This will require making better
use of the measures already available for key priority areas and
investing wisely in measure development and endorsement activities to
fill the most critical gap areas.
6. Looking Forward
NQF has evolved in the dozen years it has been in existence and
since it endorsed its first performance measures a decade ago. While
its focus on improving quality, enhancing safety, and reducing costs by
endorsing performance measures has remained a constant, its role has
expanded to include a significant emphasis on getting the various
stakeholder groups to align with respect to their use of performance
measures and related improvement efforts. Experience has made it clear
that sector-by-sector approaches to enhancing healthcare performance
are ineffective in our decentralized and complex healthcare system, and
they waste precious healthcare resources and may even do harm.
Looking ahead, NQF will work together with HHS and the broader
quality movement to:
Deepen the alignment between the public and private
sectors and across stakeholder groups to accelerate progress and reduce
burden: This relates to measure endorsement and the work of NQF-
convened partnerships and is a core, enduring value of the
organization;
Focus more on ``end user'' needs and engagement: NQF will
enlarge its current collaborative efforts to better incorporate the
perspectives and values of those at the local level and those on the
sharp end of healthcare--who ultimately are integrating the needs of
the delivery system with those who receive and pay for care. Starting
with the preferences of the end user in mind and systematically
collecting user feedback about the efficacy of measures are ways to
engage communities, providers, and other users in the collective goal
of improving healthcare value.
Take a more proactive approach to coordinate the measures
pipeline and remake measure review and endorsement so it is more
nimble: NQF will not only identify measure gaps but engage developers
in filling them so that their efforts are streamlined and avoid
duplication. Simultaneously, NQF plans to set up standing committees so
that measures can more readily be reviewed.
Review and endorse ``next generation'' quality measures
that put the patient first: A key priority is endorsing next-generation
measures that are more meaningful to patients and families and that
help track patient outcomes across healthcare settings. NQF is
committed to moving our nation's healthcare system to be ever more
responsive to patient preferences and values and believes that richer
information can play a crucial role;
Increase the focus on measures that can enhance value:
Affordability and its relationship to quality will become a focal point
and better integrated into NQF's future work, starting with defining
the many aspects of affordability and prioritizing near and longer term
areas of focus going forward. Given the embryonic stage of
affordability measures overall, there is much upfront conceptual work
to be done that will rely on getting broad-based and varied input in
order to gain a deeper appreciation for how to further measurement in
the areas of costs, appropriateness, and resource use and how to pair
such measures with quality metrics in order to assess value.
NQF is embarking on an exciting agenda that emphasizes enhanced
alignment and collaboration so as to better integrate end user needs--
all with an eye on evolving our measure portfolio so that it drives the
healthcare system toward both delivering higher value healthcare and
incorporating the needs and preferences of patients, payers, and
purchasers. The goals are clear, and the collective work of the 800
plus individuals who collaborate with NQF are focused on efforts to
benefit the U.S. healthcare system and the patients it serves.
Appendix A: 2012 Accomplishments
January 14, 2012 to January 7, 2013
----------------------------------------------------------------------------------------------------------------
Notes/scheduled or
Description Output Status (as of 1/7/2013) actual completion date
----------------------------------------------------------------------------------------------------------------
I. Facilitating Coordinated Action to Achieve the National Quality Strategy Goals
----------------------------------------------------------------------------------------------------------------
NPP support for Partnership for 4 quarterly convenings Completed................. Content of meetings and
Patients' HHS initiative for 100+ people each, webinars were captured
focused on patient safety. and 3 webinars reaching in individual
550+. summaries.
NPP support for Partnership for 2 public web meetings Completed................. Content of meetings and
Patients' HHS initiative reaching 500+ and 2 calls were captured in
focused on patient safety. public conference individual summaries.
calls, reaching 100+.
NPP support for Partnership for Formed two action teams Completed.................
Patients' HHS initiative around Readmissions and
focused on patient safety. Maternal Health. Early
development of
additional action teams
around Million Hearts/
Cardiovascular Health
and Patient & Family
Engagement.
[[Page 46715]]
NPP support for Partnership for Created the Action Completed.................
Patients' HHS initiative Registry, a virtual
focused on patient safety. space for organizations
to share their quality
improvement activities--
or ``actions''--around
the six priority areas
of the National Quality
Strategy and make
connections with each
other.
NPP support for Partnership for Quarterly reports for Completed.................
Patients' HHS initiative HHS.
focused on patient safety.
----------------------------------------------------------------------------------------------------------------
II. Supporting National Healthcare Measurement Needs
----------------------------------------------------------------------------------------------------------------
Surgery measures and maintenance Two-phase project to Completed................. Phase 1: 18 measures
review. endorse new surgery endorsed in December
measures and conduct 2011.
maintenance on existing NQF Board endorsed 24
NQF-endorsed measures. measures in Phase 2 in
January 2012.
Phase 2 addendum
endorsed 9 measures in
May 2012.
51 endorsed measures
total, 42 maintenance.
Efficiency and resource-use Endorsed measures of Completed................. Imaging Efficiency
measures. imaging efficiency; (Complete)
white paper drafted; --6 imaging efficiency
endorsed measures of measures endorsed in
healthcare efficiency. February 2011.
--1 imaging efficiency
measure was recommended
to be combined with an
existing NQF measure
and was endorsed in
April 2011.
Efficiency--Resource Use
(Complete).
Cycle 1: 4 measures
endorsed in January
2012.
Cycle 2: 4 measures
endorsed in April 2012.
--8 total measures
endorsed, zero
maintenance.
Cancer measures and maintenance Project to endorse new Completed................. Phase 1: 22 measures
review. cancer measures and endorsed October 2012,
conduct maintenance on 18 maintenance.
existing NQF-endorsed Phase 2: 16 measures
measures. endorsed in October
2012, 10 maintenance.
Perinatal measures and Project to endorse new Completed................. 14 perinatal measures
maintenance review. perinatal measures and endorsed April 2012, 12
conduct maintenance on maintenance.
existing NQF-endorsed
measures.
Renal measures and maintenance Project to endorse new Completed................. 12 renal measures
review. renal measures and endorsed April 2012,
conduct maintenance on nine maintenance.
existing NQF-endorsed
measures.
Pulmonary/critical-care measures Project to endorse new In progress............... 19 pulmonary/critical-
and maintenance review. pulmonary/critical-care care measures endorsed
measures, and conduct July 2012, 16
maintenance on existing maintenance. One
NQF-endorsed measures. additional measure
endorsed in January
2013, with two final
measures still under
review.
Palliative and end-of-life care. Project to endorse new Completed................. 14 palliative and end-of-
palliative and end-of- life care measures
life care measures and endorsed February 2012,
conduct maintenance on 2 maintenance.
existing NQF-endorsed
measures.
Care coordination measures and Set of endorsed care Completed................. 12 care coordination
maintenance review. coordination measures. measures endorsed
August 2012, 12
maintenance.
Population Health Phase 1: Set of endorsed measures Completed................. 19 population health
Prevention measures and for preventative measures endorsed May
maintenance measures review. services. 2012, 17 maintenance.
Population health Phase 2: Commissioned paper Completed................. Five measures also
Population health measures. addressing population endorsed in October
health measurement 2012, 3 maintenance.
issues and set of
endorsed population
health measures, plus
set of endorsed
measures.
Behavioral health measures and Set of endorsed measures Phase I completed, phase 2 Phase 1 endorsed 10
maintenance review. for behavioral health. slated for 2013. measures in October
2012, 4 maintenance.
All-cause readmissions Set of endorsed all- Completed................. Two all-cause
(expedited Consensus cause readmission readmissions measures
Development Process [CDP] measures. endorsed June 2012,
review). zero maintenance.
[[Page 46716]]
Multiple Chronic Conditions Work plan completed; Completed................. May 2012.
Measurement Framework report interim report
analyzing measures being used available for public
to gauge quality of care for comment.
people with multiple chronic
conditions.
Patient-reported outcomes (PROs) Two workshops discussing Completed................. Final report completed
workshops addressing commissioned papers December 2012.
prerequisites for endorsed PRO addressing
measures. methodological
prerequisites for NQF
consideration of PRO
measures for
endorsement.
Oral health..................... Report that catalogs Completed................. July 2012.
oral health measures,
measure concepts,
priorities and gaps in
measurement.
Rapid-cycle CDP improvement Summary of process Completed................. May 2012.
(measure-endorsement process). improvement approach,
events, and metrics
used to enhance the
quality and efficiency
of CDP process.
GI/GU Two-Stage CDP............. Proposed two-stage pilot Stage 1 completed......... 12 measure concepts
project designed to approved in December
provide early guidance 2012.
to measure developers
on whether a measure
concept meets NQF's
criterion for
importance to measure
and report before they
invest time and
resources in specifying
and testing a measure.
Patient-safety-complications Set of endorsed measures Completed................. 14 measures endorsed
measures and maintenance review on complications- June 2012, 14
(Phase 1). related areas. maintenance.
2 additional measures
endorsed August 2012. 2
maintenance.
16 measures total, 16
maintenance.
Infectious disease measures and Set of endorsed In progress............... 14 measures endorsed
maintenance review. infectious disease January 2013, 10
measures. maintenance. Two
measures still under
review.
Regionalized Emergency Medical Provide guidance for Completed.................
Care Services measure topic measure development to
prioritization. ASPR's prioritized
areas of (1) ED
crowding, including a
specific focus on
boarding and diversion,
(2) emergency
preparedness, and (3)
surge capacity.
Registry Needs Assessment....... Hosted a public workshop Completed.................
that discussed measure
information needs,
requirements, and
potential approaches to
measure information
management, as well as
2 webinars--focused on
measure information
management systems and
a discussion on major
findings of the
workshop, respectively.
Final report summarized
major findings and
included public
feedback.
Common formats for patient Responsible--on behalf Completed.................
safety data. of AHRQ--for
coordinating a process
to obtain comments from
stakeholders about the
Common Formats
authorized by the
Patient Safety and
Quality Improvement Act
of 2005.
QDM maintenance................. Updated the QDM to Completed................. Work stopped effective 1/
incorporate additional 10/13 as a result of
types of measurement amendments made by the
data needed to support American Taxpayer
emerging measures. The Relief Act.
QDM June 2012 Update
was released in summer
for public comment.
The QDM December 2012
was released in
December based on
feedback from the 2014
Clinical Quality
Measure (CQM)
development cycle for
Meaningful Use Stage 2.
MAT............................. Non-proprietary, web- Completed................. CMS assumed day-to-day
based tool that allows responsibilities of the
performance-measure MAT as of January 2013.
developers to specify,
submit, and maintain
electronic measures in
a more streamlined,
efficient, and highly
structured way.
[[Page 46717]]
Refinement of the eMeasure Provided education and Ongoing................... Launched and maintained
Process and Technical outreach to both HHS the Health IT Knowledge
Assistance. and its contractors, Base which includes
and to the users of frequently asked
QDM, eMeasures, and the questions (FAQs) from
Measure Authoring Tool: webinars, technical
Measure developers, EHR assistance log, user
vendors, and providers feedback, etc., a
implementing measures. glossary of terms and
This education and links to Health IT
outreach included both reports. Updated and
interactive teaching maintained the Measure
through webinars and Authoring Tool (MAT)
live presentations, as User Guide. Provided
well as development of technical assistance to
technical information HHS/ONC/CMS eMeasure
posted on NQF's Web contractors focusing on
site. Technical support topics such as QDM and
was also provided to eMeasure logic in
HHS/CMS/ONC as needed. preparation for the
release of MU2.
Participated in
eMeasure support calls
and meeting as
requested by ONC and
CMS.
Commissioned paper on data Final report and Completed................. April 2012.
sources and readiness of HIT commissioned paper.
systems to support care
coordination.
Critical Paths.................. Examine new measurement Completed................. Patient Safety and Care
areas (e.g., care Coordination final
plans) to understand reports completed in
the feasibility of October and November
measuring such areas in 2012.
an electronic
environment.
eMeasure Learning Collaborative. Examining issues related Completed................. Final report completed
to implementation of in December 2012.
eMeasures with a multi-
stakeholder group in
order to define best
practices and
recommendations to the
Office of the National
Coordinator's Federal
Advisory Committees.
eMeasure feasibility testing.... Review the current state In progress............... Draft guidance report to
of feasibility be finalized and
assessment for released for public
eMeasures and identify comment. Slated for
a set of principles, completion by 4/5/13.
recommendations, and
criteria for adequate
feasibility assessment.
Composite evaluation guidance... Reassess NQF's existing In progress............... Final report slated for
guidance for evaluating completion by 4/5/13.
composites, with
particular
consideration of recent
changes in composite
measure development and
related methodology.
----------------------------------------------------------------------------------------------------------------
III. Aligning Accountability Programs to Enhance Value
----------------------------------------------------------------------------------------------------------------
Measures for use in quality Measure Applications Completed................. Completed February 2012.
reporting programs under Partnership Pre-
Medicare. Rulemaking Report:
Input on Measures Under
Consideration by HHS
for 2012 Rulemaking.
MAP report recommending measures Final report including Completed................. June 1, 2012.
that address the quality issues potential new
identified for dual-eligible performance measures to
beneficiaries. fill gaps in
measurement for dual-
eligible beneficiaries.
MAP report recommending measures Final report including Completed................. June 1, 2012.
for use in quality reporting MAP Coordinating
for Prospective Payment System- Committee
exempt cancer hospitals. recommendations.
MAP report recommending measures Final report including Completed................. June 1, 2012.
for use in quality reporting MAP Coordinating
for hospice care. Committee
recommendations.
MAP Strategic Plan 2012-2015.... Final report............ Completed................. October 2012.
MAP report detailing families of Final report............ Completed................. October 2012.
measures for safety, care
coordination, cardiovascular
conditions, and diabetes.
[[Page 46718]]
IV. Identifying Measure Gaps and Developing Strategies for Filling Them
----------------------------------------------------------------------------------------------------------------
Gaps Report..................... ........................ .......................... Feedback received on 2/
8. Revised draft due
back on 3/31/13.
----------------------------------------------------------------------------------------------------------------
Appendix B: NQF Board and Management Team
Board of Directors
William L. Roper, MD, MPH (Chair), Dean, School of Medicine, Vice
Chancellor for Medical Affairs and Chief Executive Officer, UNC Health
Care System, University of North Carolina at Chapel Hill
Helen Darling, MA (Vice Chair), President, National Business Group on
Health
Gerald M. Shea (Treasurer and Interim CEO), Assistant to the President
for External Affairs, AFL-CIO
Lawrence M. Becker, Director, HR Strategic Partnerships, Xerox
Corporation
JudyAnn Bigby, MD, Secretary, Executive Office of Health & Human
Services, Commonwealth of Massachusetts
Jack Cochran, MD, FACS, Executive Director, The Permanente Federation
Maureen Corry, Executive Director, Childbirth Connection
Leonardo Cuello, Staff Attorney, National Health Law Program
Joyce Dubow, Senior Health Care Reform Director, AARP Office of the
Executive Vice-President for Policy and Strategy
Robert Galvin, MD, MBA, Chief Executive Officer, Equity Healthcare, The
Blackstone Group
Ardis Dee Hoven, MD, Chair, Board of Trustees, American Medical
Association
Charles N. Kahn III, MPH, President, Federation of American Hospitals
Donald Kemper, Chairman and CEO, Healthwise, Inc.
William Kramer, Executive Director for National Health Policy, Pacific
Business Group on Health
Harold D. Miller, President and CEO, Network for Regional Healthcare
Improvement
Elizabeth Mitchell, CEO, Maine Health Management Coalition
Dolores L. Mitchell, Executive Director, Commonwealth of Massachusetts
Group Insurance Commission
Mary Naylor, Ph.D., RN, FAAN, Director, New Courtland Center for
Transitions & Health and Marian S. Ware Professor in Gerontology,
University of Pennsylvania School of Nursing
Debra L. Ness, President, National Partnership for Women & Families
Samuel R. Nussbaum, MD, Executive Vice President and Chief Medical
Officer, WellPoint, Inc.
J. Marc Overhage, MD, Ph.D., Chief Medical Informatics Officer, Siemens
Medical Solutions, Inc.
Bernard M. Rosof, MD, Chair, Board of Directors, Huntington Hospital,
Chair, Physician Consortium for Performance Improvement (PCPI)
John C. Rother, JD, President and CEO, National Coalition on Health
Care
Bruce Siegel, MD, MPH, President and Chief Executive Officer, National
Association of Public Hospitals and Health Systems (NAPH)
Joseph R. Swedish, FACHE, President and CEO, Trinity Health
John Tooker, MD, MBA, MACP, Associate Executive Vice President,
American College of Physicians
Richard J. Umbdenstock, FACHE, President and CEO, American Hospital
Association
CMS
Patrick Conway, MD, Chief Medical Officer, Centers for Medicare &
Medicaid Services
AHRQ
Carolyn M. Clancy, MD, Director, Agency for Healthcare Research and
Quality
Designee: Nancy Wilson, MD, MPH, Senior Advisor to the Director
HRSA
Mary Wakefield, Ph.D., RN, Administrator, Health Resources and Services
Administration
Designee: Terry Adirim, MD, Director, Office of Special Health Affairs
CDC
Thomas R. Frieden, MD, MPH, Director, Centers for Disease Control and
Prevention
Designee: Peter A. Briss, MD, MPH, Captain, U.S. Public Health Service,
Medical Director
EX OFFICIO (NON-VOTING):
Ann Monroe, (Chair, Consensus Standards Approval Committee), President,
Health Foundation for Western and Central New York
Paul C. Tang, MD, MS, (Chair, Health Information Technology Advisory
Committee) Vice President and Chief Medical Information Officer Palo
Alto Medical Foundation
Management Team
Gerald Shea, Interim Chief Executive Officer
Karen Adams, Vice President, National Priorities
Heidi Bossley, Vice President, Performance Measures
Helen Burstin, Senior Vice President, Performance Measures
Ann Greiner, Vice President, Government Relations
Ann Hammersmith, General Counsel
Lisa Hines, Vice President, Member Relations
Rosemary Kennedy, Vice President, Health Information Technology
Nicole Silverman, Vice President, Program Operations
Lindsey Spindle, Senior Vice President, Communications and External
Affairs
Diane Stollenwerk, Vice President, Stakeholder Collaboration
Jeffrey Tomitz, Chief Financial Officer, Accounting & Finance
Thomas Valuck, Senior Vice President, Strategic Partnerships
Kyle Vickers, Chief Information Office
Appendix C: MAP ``Working'' Measure Selection Criteria
1. Measures Within the Program Measure Set Are NQF-endorsed or Meet the
Requirements for Expedited Review
Measures within the program measure set are NQF-endorsed,
indicating that they have met the following criteria: important to
measure and report, scientifically acceptable measure properties,
usable, and feasible. Measures within the program measure set that are
not NQF-endorsed but meet requirements for expedited review, including
measures in widespread use and/or tested, may be recommended by MAP,
contingent on subsequent endorsement. These measures will be submitted
for expedited review.
Response option: Strongly Agree/Agree/Disagree/Strongly Disagree
[[Page 46719]]
Measures within the program measure set are NQF-endorsed or meet
requirements for expedited review (including measures in widespread use
and/or tested)
Additional Implementation Consideration: Individual endorsed measures
may require additional discussion and may be excluded from the program
measure set if there is evidence that implementing the measure would
result in undesirable unintended consequences.
2. Program Measure Set Adequately Addresses Each of the National
Quality Strategy (NQS) priorities
Demonstrated by measures addressing each of the National Quality
Strategy (NQS) priorities:
Subcriterion 2.1 Safer care
Subcriterion 2.2 Effective care coordination
Subcriterion 2.3 Preventing and treating leading causes of mortality
and morbidity
Subcriterion 2.4 Person- and family-centered care
Subcriterion 2.5 Supporting better health in communities
Subcriterion 2.6 Making care more affordable
Response option for each subcriterion: Strongly Agree/Agree/Disagree/
Strongly Disagree:
NQS priority is adequately addressed in the program measure set
3. Program Measure Set Adequately Addresses High-impact Conditions
Relevant to the Program's Intended Population(s) (e.g., Children, Adult
non-Medicare, Older Adults, Dual Eligible Beneficiaries)
Demonstrated by the program measure set addressing Medicare High-
Impact Conditions; Child Health Conditions and risks; or conditions of
high prevalence, high disease burden, and high cost relevant to the
program's intended population(s). (Refer to tables 1 and 2 for Medicare
High-Impact Conditions and Child Health Conditions determined by the
NQF Measure Prioritization Advisory Committee.)
Response option: Strongly Agree/Agree/Disagree/Strongly Disagree:
Program measure set adequately addresses high-impact conditions
relevant to the program.
4. Program Measure Set Promotes Alignment With Specific Program
Attributes, as Well as Alignment Across Programs
Demonstrated by a program measure set that is applicable to the
intended care setting(s), level(s) of analysis, and population(s)
relevant to the program.
Response option for each subcriterion:
Strongly Agree/Agree/Disagree/Strongly Disagree
Subcriterion 4.1 Program measure set is applicable to the program's
intended care setting(s)
Subcriterion 4.2 Program measure set is applicable to the program's
intended level(s) of analysis
Subcriterion 4.3 Program measure set is applicable to the program's
population(s)
5. Program Measure Set Includes an Appropriate Mix of Measure Types
Demonstrated by a program measure set that includes an appropriate
mix of process, outcome, experience of care, cost/resource use/
appropriateness, and structural measures necessary for the specific
program attributes.
Response option for each subcriterion: Strongly Agree/Agree/Disagree/
Strongly Disagree
Subcriterion 5.1 Outcome measures are adequately represented in the
program measure set
Subcriterion 5.2 Process measures are adequately represented in the
program measure set
Subcriterion 5.3 Experience of care measures are adequately represented
in the program measure set (e.g. patient, family, caregiver)
Subcriterion 5.4 Cost/resource use/appropriateness measures are
adequately represented in the program measure set
Subcriterion 5.5 Structural measures and measures of access are
represented in the program measure set when appropriate
6. Program Measure Set Enables Measurement Across the Person-Centered
Episode of Care \1\
---------------------------------------------------------------------------
\1\ National Quality Forum (NQF), Measurement Framework:
Evaluating Efficiency Across Patient-Focused Episodes of Care,
Washington, DC: NQF; 2010.
---------------------------------------------------------------------------
Demonstrated by assessment of the person's trajectory across
providers, settings, and time.
Response option for each subcriterion: Strongly Agree/Agree/Disagree/
Strongly Disagree
Subcriterion 6.1 Measures within the program measure set are applicable
across relevant providers
Subcriterion 6.2 Measures within the program measure set are applicable
across relevant settings
Subcriterion 6.3 Program measure set adequately measures patient care
across time
7. Program Measure Set Includes Considerations for Healthcare
Disparities \2\
---------------------------------------------------------------------------
\2\ NQF, Healthcare Disparities Measurement, Washington, DC:
NQF; 2011.
---------------------------------------------------------------------------
Demonstrated by a program measure set that promotes equitable
access and treatment by considering healthcare disparities. Factors
include addressing race, ethnicity, socioeconomic status, language,
gender, age disparities, or geographical considerations (e.g., urban
vs. rural). Program measure set also can address populations at risk
for healthcare disparities (e.g., people with behavioral/mental
illness).
Response option for each subcriterion: Strongly Agree/Agree/Disagree/
Strongly Disagree
Subcriterion 7.1 Program measure set includes measures that directly
assess healthcare disparities (e.g., interpreter services)
Subcriterion 7.2 Program measure set includes measures that are
sensitive to disparities measurement (e.g., beta blocker treatment
after a heart attack)
8. Program Measure Set Promotes Parsimony
Demonstrated by a program measure set that supports efficient
(i.e., minimum number of measures and the least effort) use of
resources for data collection and reporting and supports multiple
programs and measurement applications. The program measure set should
balance the degree of effort associated with measurement and its
opportunity to improve quality.
Response option for each subcriterion: Strongly Agree/Agree/Disagree/
Strongly Disagree
Subcriterion 8.1 Program measure set demonstrates efficiency (i.e.,
minimum number of measures and the least burdensome)
Subcriterion 8.2 Program measure set can be used across multiple
programs or applications (e.g., Meaningful Use, Physician Quality
Reporting System [PQRS])
Table 1--National Quality Strategy Priorities
------------------------------------------------------------------------
-------------------------------------------------------------------------
1. Making care safer by reducing harm caused in the delivery of care.
2. Ensuring that each person and family is engaged as partners in their
care.
3. Promoting effective communication and coordination of care.
4. Promoting the most effective prevention and treatment practices for
the leading causes of mortality, starting with cardiovascular disease.
[[Page 46720]]
5. Working with communities to promote wide use of best practices to
enable healthy living.
6. Making quality care more affordable for individuals, families,
employers, and governments by developing and spreading new healthcare
delivery models.
------------------------------------------------------------------------
Table 2--High-Impact Conditions
------------------------------------------------------------------------
-------------------------------------------------------------------------
Medicare Conditions:
1. Major Depression.
2. Congestive Heart Failure.
3. Ischemic Heart Disease.
4. Diabetes.
5. Stroke/Transient Ischemic Attack.
6. Alzheimer's Disease.
7. Breast Cancer.
8. Chronic Obstructive Pulmonary Disease.
9. Acute Myocardial Infarction.
10. Colorectal Cancer.
11. Hip/Pelvic Fracture.
12. Chronic Renal Disease.
13. Prostate Cancer.
14. Rheumatoid Arthritis/Osteoarthritis.
15. Atrial Fibrillation.
16. Lung Cancer.
17. Cataract.
18. Osteoporosis.
19. Glaucoma.
20. Endometrial Cancer.
Child Health Conditions and Risks:
1. Tobacco Use.
2. Overweight/Obese (>=85th percentile BMI for age).
3. Risk of Developmental Delays or Behavioral Problems.
4. Oral Health.
5. Diabetes.
6. Asthma.
7. Depression.
8. Behavior or Conduct Problems.
9. Chronic Ear Infections (3 or more in the past year).
10. Autism, Asperger's, PDD, ASD.
11. Developmental Delay (diag.).
12. Environmental Allergies (hay fever, respiratory or skin
allergies).
13. Learning Disability.
14. Anxiety Problems.
15. ADD/ADHD.
16. Vision Problems not Corrected by Glasses.
17. Bone, Joint, or Muscle Problems.
18. Migraine Headaches.
19. Food or Digestive Allergy.
20. Hearing Problems.
21. Stuttering, Stammering, or Other Speech Problems.
22. Brain Injury or Concussion.
23. Epilepsy or Seizure Disorder.
24. Tourette Syndrome.
------------------------------------------------------------------------
Appendix D: 2012 NQF Expert Participant Leaders (organized by
committee)
Behavioral Health Steering Committee
Peter Briss, Co-Chair, National Center for Chronic Disease Prevention
and Health Promotion
Harold Pincus, Co-Chair, Columbia University
Cancer Steering Committee
Stephen Edge, Co-Chair, Roswell Park Cancer Institute
Stephen Lutz, Chair, Blanchard Valley Regional Cancer Center
Cardiovascular Endorsement Maintenance 2010 Steering Committee
Mary George, Vice Chair, Centers for Disease Control and Prevention
Raymond Gibbons, Chair, Mayo Clinic
Care Coordination Steering Committee
Donald Casey, Co-Chair, Atlantic Health
Gerri Lamb, Co-Chair, Arizona State University
Common Formats Expert Panel
David Classen, Co-Chair, University of Utah School of Medicine
Henry Johnson, Co-Chair, ACS-MIDAS+
Council Leadership
Tanya Alteras, Chair, National Partnership for Women & Families
Maureen Corry, Vice Chair, Childbirth Connection
Deborah Fritz, Vice Chair, GlaxoSmithKline
Seiji Hayashi, Chair, Health Resources and Services Administration
David Hopkins, Chair, Pacific Business Group on Health
Thomas James, Chair, Humana Inc.
Carol Mullin, Chair, Virtua Health
Michael Phelan, Vice Chair, Cleveland Clinic
Louise Probst, Vice Chair, St. Louis Area Business Health Coalition
William Rich, Chair, Northern Virginia Ophthalomology Associates
Richard Salmon, Vice Chair, CIGNA HealthCare
David Shahian, Vice Chair, Massachusetts General Hospital
Kathleen Shoemaker, Chair, Lilly USA, LLC
Hussein Tahan, Vice Chair, New York Presbyterian Healthcare System
Marcia Wilson, Chair, Center for Health Care Quality
CSAC: Consensus Standards Approval Committee
Ann Monroe, Chair, Vice Chair, Health Foundation for Central & Western
New York
Frank Opelka, Vice Chair, American College of Surgeons
GI & GU Pilot Project Steering Committee
Andrew Baskin, Co-Chair, Aetna
Christopher Saigal, Co-Chair, UCLA Medical Center
Health Information Technology Advisory Committee
J. Marc Overhage, Vice Chair, Siemens Medical Solutions USA, Inc.
Paul Tang, Chair, Palo Alto Medical Foundation
Healthcare Disparities & Cultural Competency Steering Committee
Dennis Andrulis, Co-Chair, Texas Health Institute
Denice Cora-Bramble, Co-Chair, Children's National Medical Center
HITAC Change Control Board
Floyd Eisenberg, Chair, NQF
HITAC Oversight and Testing Workgroup
Michael Lieberman, Chair, Oregon Health and Sciences University
HITAC Quality Data Model Subcommittee
David Bates, Chair, Brigham and Women's Hospital
Caterina Lasome, Co-Chair, iON Informatics, LLC
Infectious Disease Steering Committee
Steven Brotman, Co-Chair, The Advanced Medical Technology Association
(AdvaMed)
Edward Septimus, Co-Chair, HCA
Leadership Network
William Corley, Chair, Community Health Network
MAP Cardiovascular and Diabetes Care Task Force
Christine Cassel, Chair, American Board of Internal Medicine
MAP Safety and Care Coordination Task Force
Frank Opelka, Chair, American College of Surgeons
MAP Strategy Task Force 2
Charles Kahn, Co-Chair, Federation of American Hospitals
Gerald Shea, Co-Chair, AFL-CIO
Measure Applications Partnership Clinician Workgroup
Mark McClellan, Chair, The Brookings Institute
Measure Applications Partnership Coordinating Committee
George Isham, Co-Chair, HealthPartners
Elizabeth McGlynn, Co-Chair, Kaiser Permanente Center for Effectiveness
& Safety Research
[[Page 46721]]
Measure Applications Partnership Dual Eligibles Workgroup
Alice Lind, Chair, Center for Health Care Strategies, Inc
Measure Applications Partnership Hospital Workgroup
Frank Opelka, Chair, American College of Surgeons
Measure Applications Partnership PAC-LTC Workgroup
Carol Raphael, Chair, Visiting Nurse Service of New York
Multiple Chronic Conditions Measurement Framework Steering Committee
Caroline Blaum, Co-Chair, DVAMC GRECC Institute of Gerontology
Barbara McCann, Co-Chair, Interim HealthCare Inc.
National Priorities Partnership
Helen Darling, Co-Chair, National Business Group on Health
Bernard Rosof, Co-Chair, American Medical Association-Physician
Consortium for Performance Improvement
Neurology Steering Committee
David Knowlton, Co-Chair, New Jersey Health Care Quality Institute
David Tirschwell, Co-Chair, University of Washington, Department of
Neurology
NPP Maternity Action Team
Maureen Corry, Co-Chair, Childbirth Connection
Bernard Rosof, Co-Chair, American Medical Association-Physician
Consortium for Performance Improvement
NPP Readmissions Action Team
Helen Darling, Co-Chair, National Business Group on Health
Susan Frampton, Co-Chair, Planetree
Oral Health Expert Panel
Paul Glassman, Co-Chair, University of the Pacific School of Dentistry
David Krol, Co-Chair, The Robert Wood Johnson Foundation
Palliative Care and End of Life Care Steering Committee
June Lunney, Co-Chair, Hospice and Palliative Nurses Association
Sean Morrison, Co-Chair, Mount Sinai School of Medicine--Dept. of
Geriatrics & Palliative Medicine
Patient Safety State Based Reporting Work Group
Michael Doering, Co-Chair, Pennsylvania Patient Safety Authority
Diane Rydrych, Co-Chair, Minnesota Department of Health
Iona Thraen, Co-Chair, Utah Department of Health
Patient Safety-Measures Complications Steering Committee
Pamela Cipriano, Co-Chair, University of Virginia Health System
William Conway, Co-Chair, Henry Ford Health System
Perinatal and Reproductive Health Steering Committee
Laura Riley, Co-Chair, Massachusetts General Hospital
Carol Sakala, Co-Chair, Childbirth Connection
Population Health Steering Committee
Paul Jarris, Co-Chair, Association of State and Territorial Health
Officers
Kurt Stange, Co-Chair, Case Western Reserve University
Pulmonary Steering Committee
Stephen Grossbart, Co-Chair, Catholic Health Partners
Kevin Weiss, Co-Chair, American Board of Medical Specialties
Readmissions Expedited Review Steering Committee
Sherrie Kaplan, Co-Chair, UC Irvine School of Medicine
Eliot Lazar, Co-Chair, New York Presbyterian Healthcare System
Regionalized Emergency Medical Care Services Steering Committee
Arthur Kellermann, Co-Chair, The RAND Corporation
Andrew Roszak, Co-Chair, HHS\HRSA
Resource Use Project Cancer TAP
David Penson, Chair, Vanderbilt University Medical Center
Resource Use Project Cardio/Diab TAP
Jeptha Curtis, Co-Chair, Yale University School of Medicine
James Rosenzweig, Co-Chair, Boston Medical Center and Boston University
School of Medicine
Resource Use Project: Bone/Joint TAP
James Weinstein, Chair, Dartmouth-Hitchcock Medical Center
Resource Use Project: Pulmonary TAP
Kurtis Elward, Co-Chair, Family Medicine of Albermarle
Janet Maurer, Co-Chair, American College of Chest Physicians
Appendix E: 2012 NQF Expert Participants (organized by affiliation)
Barbara Kelly--A.F. Williams Family Medicine Center
Joyce Dubow--AARP
Naomi Karp--AARP
Susan Reinhard--AARP
Judith Cahill--Academy of Managed Care Pharmacy
Marissa Schlaifer--Academy of Managed Care Pharmacy
Henry Johnson--ACS-MIDAS+
Madhavi Vemireddy--ActiveHealth Management
Henry Claypool--Administration for Community Living, HHS
Joanne Armstrong--Aetna
Andrew Baskin--Aetna
Thomas Howe--Aetna
Randall Krakauer--Aetna
Patricia McDermott--Aetna
Gerald Shea--AFL-CIO
Marie Kokol--Agency for Health Care Administration
Carolyn Clancy--Agency for Healthcare Research and Quality
Erin Grace--Agency for Healthcare Research and Quality
Darryl Gray--Agency for Healthcare Research and Quality
Ernest Moy--Agency for Healthcare Research and Quality
William Munier--Agency for Healthcare Research and Quality
Mary Nix--Agency for Healthcare Research and Quality
Mamatha Pancholi--Agency for Healthcare Research and Quality
D.E.B. Potter--Agency for Healthcare Research and Quality
Judith Sangl--Agency for Healthcare Research and Quality
Nancy Wilson--Agency for Healthcare Research and Quality
MaryAnne Lindeblad--Aging and Disability Services Administration
Sam Fazio--Alzheimer's Association
Beth Kallmyer--Alzheimer's Association
Julie Lewis--Amedisys
Bruce Bagley--American Academy of Family Physicians
Dennis Saver--American Academy of Family Physicians
Dale Lupu--American Academy of Hospice and Palliative Medicine
Jack Scariano--American Academy of Neurology
Mary Jo Goolsby--American Academy of Nurse Practitioners
Douglas Burton--American Academy of Orthopaedic Surgeons
John Ratliff--American Association of Neurological Surgeons
Christine Zambricki--American Association of Nurse Anesthetists
Margaret Nygren--American Association on Intellectual and Developmental
Disabilities
Christine Cassel--American Board of Internal Medicine
Lorna Lynn--American Board of Internal Medicine
Denece Kesler--American Board of Medical Specialties
[[Page 46722]]
Kevin Weiss--American Board of Medical Specialties
Larry Gilstrap--American Board of Obstetrics and Gynecology
Mary Maryland--American Cancer Society Illinois Division
Janet Maurer--American College of Chest Physicians
Lisa Moores--American College of Chest Physicians
Lorrie Kaplan--American College of Nurse-Midwives
Sean Currigan--American College of Obstetricians and Gynecologists
Gerald Joseph--American College of Obstetricians and Gynecologists
Sandra Fryhofer--American College of Physicians
Amir Qaseem--American College of Physicians
Don Detmer--American College of Surgeons
Bruce Hall--American College of Surgeons
Frank Opelka--American College of Surgeons
Sally Tyler--American Federation of State, County and Municipal
Employees
Jennie Hansen--American Geriatrics Society
David Gifford--American Health Care Association
Ruta Kadonoff--American Health Care Association
Naomi Naierman--American Hospice Foundation
Nancy Foster--American Hospital Association
Richard Umbdenstock--American Hospital Association
Kalpana Ramiah--American Institutes for Research
Norman Edelman--American Lung Association
Kendra Hanley--American Medical Association
Delane Heldt--American Medical Association-Physician Consortium for
Performance Improvement
Bernard Rosof--American Medical Association-Physician Consortium for
Performance Improvement
James Lett--American Medical Directors Association
Sam Lin--American Medical Group Association
Maureen Dailey--American Nurses Association
Marla Weston--American Nurses Association
Patricia Conway-Morana--American Organization of Nurse Executives
Dianne Jewell--American Physical Therapy Association
Arden Morris--American Society of Colon and Rectal Surgeons
Shekhar Mehta--American Society of Health-System Pharmacists
Janet Brown--American Speech-Language-Hearing Association
Aparna Higgins--America's Health Insurance Plans
Andrea Gelzer--AmeriHealth Mercy Family of Companies
Richard Dutton--Anesthesia Quality Institute
Jay Schukman--Anthem Blue Cross and Blue Shield
Michael Helgeson--Apple Tree Dental
Gerri Lamb--Arizona State University
Craig Gilliam--Arkansas Children's Hospital
Catherine Tapp--Arkansas Department of Health and Human Services
Ann Hendrich--Ascension Health
Sarah Hill--Ascension Health
Joanne Conroy--Association of American Medical Colleges
Marilyn Bowman-Hayes--Association of periOperative Registered Nurses
Paul Jarris--Association of State and Territorial Health Officers
Shawn Polk--Association of State and Territorial Health Officials
Donald Casey--Atlantic Health
Michael Cantine--Atlantic Health
Roger Kurlan--Atlantic Health
Rhonda Anderson--Banner Health System
Ann de Velasco--Baptist Health South Florida
Thomas Giordano--Baylor College of Medicine
Jochen Profit--Baylor College of Medicine
Carl Couch--Baylor Health Care System
Jean De Leon--Baylor Health Care System
Robert Fine--Baylor Health Care System
Robert Watson--Baylor Health Care System
David Hackney--Beth Israel Deaconess Medical Center
Nancy Ridley--Betsy Lehman Center for Patient Safety and Medical Error
Reduction
Patrick Murray--Better Health Greater Cleveland
Debra Bakerjian--Betty Irene Moore School of Nursing
Tiffany Osborn--BJC HealthCare
Stephen Lutz--Blanchard Valley Regional Cancer Center
Jane Franke--Blue Cross Blue Shield of Massachusetts
Greg Pawlson--BlueCross BlueShield Association
Carol Wilhoit--BlueCross BlueShield of Illinois
Kristine Anderson--BoozAllenHamilton
George Philippides--Boston Medical Center
James Rosenzweig--Boston Medical Center
Jeffrey Samet--Boston University School of Medicine
Lewis Kazis--Boston University School of Public Health
David Bates--Brigham and Women's Hospital
Daniel Forman--Brigham and Women's Hospital
Bruce Koplan--Brigham and Women's Hospital
Jeffrey Greenberg--Brigham and Women's Physicians' Organization
Richard Zane--Brigham Women's Hospital
Barbara Caress--Building Services 32BJ Health Fund
Lisa Shea--Butler Hospital
Carolyn Pare--Buyers Health Care Action Group
Neal Kohatsu--California Department of Health Care Services
Loriann DeMartini--California Department of Public Health
Kathleen O'Malley--California HealthCare Foundation
Ellen Wu--California Pan-Ethnic Health Network
Evelyn Calvillo--California State University
Janet Young--Carilion Health Systems
Jennifer Brandenburg--Carle Foundation Hospital
Suzanne Snyder--Carolinas Rehabilitation
Kurt Stange--Case Western Reserve University
Suzanne Delbanco--Catalyst for Payment Reform
Gail Amundson--Caterpillar Inc.
Stephen Grossbart--Catholic Health Partners
Zab Mosenifar--Cedars Sinai Medical Center
Kimberly Gregory--Cedars-Sinai Medical Center
Michael Langberg--Cedars-Sinai Medical Center
Rekha Murthy--Cedars-Sinai Medical Center
David Palestrant--Cedars-Sinai Medical Center
Marcia Wilson--Center for Health Care Quality, Department of Health
Policy, George Washington University
Alice Lind--Center for Health Care Strategies, Inc
Elliot Sloane--Center for Healthcare Information Research and Policy
Arthur Levin--Center for Medical Consumers
Alfred Chiplin Jr.--Center for Medicare Advocacy, Inc.
Patricia Nemore--Center for Medicare Advocacy, Inc.
Terrence Batliner--Center for Native Oral Health Research
Diane Meier--Center to Advance Palliative Care
Peter Briss--Centers for Disease Control and Prevention
William Callaghan--Centers for Disease Control and Prevention
Mary George--Centers for Disease Control and Prevention
[[Page 46723]]
Catherine Gordon--Centers for Disease Control and Prevention
Gail Janes--Centers for Disease Control and Prevention
Chesley Richards--Centers for Disease Control and Prevention
Patrick Conway--Centers for Medicare & Medicaid Services
Maria Durham--Centers for Medicare & Medicaid Services
Kate Goodrich--Centers for Medicare & Medicaid Services
Shaheen Halim--Centers for Medicare & Medicaid Services
Shari Ling--Centers for Medicare & Medicaid Services
Cheryl Powell--Centers for Medicare & Medicaid Services
Michael Rapp--Centers for Medicare & Medicaid Services
Ashley Ridlon--Centers for Medicare & Medicaid Services
Marsha Smith--Centers for Medicare & Medicaid Services
Erin Smith--Centers for Medicare & Medicaid Services
Judith Tobin--Centers for Medicare & Medicaid Services
Alisa Ray--Certification Commission for Healthcare Information
Technology
Parinda Khatri--Cherokee Health Systems
Maureen Corry--Childbirth Connection
Carol Sakala--Childbirth Connection
Ellen Schwalenstocker--Children's Hospital Association
Richard Antonelli--Children's Hospital Boston
Jenifer Lightdale--Children's Hospital Boston
Mark Schuster--Children's Hospital Boston
Trude Haecker--Children's Hospital of Philadelphia
David Einzig--Children's Hospitals and Clinics of Minnesota
Carol Kemper--Children's Mercy Hospital
Denice Cora-Bramble--Children's National Medical Center
David Stockwell--Children's National Medical Center
Joseph Wright--Children's National Medical Center
William Weintraub--Christiana Care Health System
Colette Edwards--CIGNA HealthCare
Mary Kay O'Neill--CIGNA HealthCare
Richard Salmon--CIGNA HealthCare
Uma Kotagal--Cincinnati Children's Hospital Medical Center
Thomas Loyacono--City of Baton Rouge and Parish of East Baton Rouge
Joseph Alvarnas--City of Hope
Jo Ann Brooks--Clarian Health
Jocelyn Bautista--Cleveland Clinic
Sung Hee Leslie Cho--Cleveland Clinic
Irene Katzan--Cleveland Clinic
David Lang--Cleveland Clinic
Thomas Marwick--Cleveland Clinic
Michael Phelan--Cleveland Clinic
Shannon Phillips--Cleveland Clinic
Allan Siperstein--Cleveland Clinic
Sharon Sutherland--Cleveland Clinic
Timothy Gilligan--Cleveland Clinic
Stanley Pestotnik--Cognovant, Inc.
Chris Tonozzi--Colorado Associated Community Health Information
Enterprise
Kim Johnson--Colorado Department of Public Health and Environment
Wendy Tenzyk--Colorado Public Employees' Retirement Association
Arthur Cooper--Columbia University
Jacqueline Merrill--Columbia University
Bobbie Berkowitz--Columbia University School of Nursing
Lawrence Gottlieb--Commonwealth Care Alliance
Roger Snow--Commonwealth of Massachusetts
Dolores Mitchell--Commonwealth of Massachusetts --Group Insurance
Commission
William Corley--Community Health Network
Andrea Benin--Connecticut Children's Medical Center
Cheryl Theriault--Connecticut Department of Health
Mary Alice Lee--Connecticut Voices for Children
E. Clarke Ross--Consortium for Citizens with Disabilities
Lawrence Sadwin--Consultant
Adam Thompson--Consultant
Richard Hanke--Consumer Representative
Robert Ellis--Consumers' Checkbook
Robert Krughoff--Consumers' Checkbook
Steven Findlay--Consumers Union
Lisa McGiffert--Consumers Union
Doris Peter--Consumers Union
Andrea Russo--Cooper University Hospital
Russell Acevedo--Crouse Hospital
Dolores Kelleher--D Kelleher Consulting
Richard Goldstein--Dana-Farber Cancer Institute
Saul Weingart--Dana-Farber Cancer Institute
John Wasson--Dartmouth-Hitchcock Medical Center
James Weinstein--Dartmouth-Hitchcock Medical Center
Linda Wilkinson--Dartmouth-Hitchcock Medical Center
Erik Pupo--Deloitte Consulting, LLP
Richard Albert--Denver Health Medical Center
Edward Havranek--Denver Health Medical Center
Philip Mehler--Denver Health Medical Center
Feseha Woldu--Department of Health and Human Services
Mary Sieggreen--Detroit Medical Center
Margaret Campbell--Detroit Receiving Hospital
Sharon Baskerville--District of Columbia Primary Care Association
Steve Morgenstern--Dow Chemical Company
Gwendolen Buhr--Duke University Health System
Sean O'Brien--Duke University Health System
John Clarke--ECRI Institute
Kathleen Shoemaker--Eli Lilly and Company
Nicole Tapay--Eli Lilly and Company
AnnMarie Papa--Emergency Nurses Association
Kathleen Szumanski--Emergency Nurses Association
Ricardo Martinez--Emory University School of Medicine
Amit Popat--Epic Systems Corp
Stanley Davis--Fairview Health Services
Brent Asplin--Fairview Medical Group
Kathleen Kelly--Family Caregiver Alliance
Kurtis Elward--Family Medicine of Albermarle
Allen McCullough--Fayette County Public Safety
Charles Kahn--Federation of American Hospitals
Nick Nudell--FirstWatch Solutions, Inc.
Joseph Ouslander--Florida Atlantic University
Laurie Burke--Food and Drug Administration
Jay Crowley--Food and Drug Administration
Behnaz Minaei--Food and Drug Administration
Terrie Reed--Food and Drug Administration
Terry Rogers--Foundation for Health Care Quality
Dwight Kloth--Fox Chase Cancer Center
Barbara Levy--Franciscan Health System
Dana Alexander--GE Healthcare
Brandon Savage--GE Healthcare
James Walker--Geisinger Health System
Andrew Guccione--George Mason University
Mayri Leslie--George Washington University
Robert Graham--George Washington University--School of Public Health
Michael Stoto--Georgetown University
Leslee Pool--Georgia Department of Health and Human Resources+D306
Rohit Borker--GlaxoSmithKline
Deborah Fritz--GlaxoSmithKline
Brenda Parker--GlaxoSmithKline
Richard Stanford--GlaxoSmithKline
John Derr--Golden Living, LLC
Connie Steed--Greenville Hospital System
Jason Colquitt--Greenway Medical Technologies
[[Page 46724]]
Anne Cohen--Harbage Consulting
John Gore--Harborview Medical Center
Ronald Maier--Harborview Medical Center
Paula Minton Foltz--Harborview Medical Center
David Spach--Harborview Medical Center
David Tirschwell--Harborview Medical Center
Jeffrey Greenwald--Harvard Medical School
Elsbeth Kalenderian--Harvard School of Dental Medicine
Ashish Jha--Harvard School of Public Health
Christine Klotz--Health Foundation for Central & Western New York
Ann Monroe--Health Foundation for Central & Western New York
Lyn Paget--Health Policy Partners
Ahmed Calvo--Health Resources and Services Administration
Ian Corbridge--Health Resources and Services Administration
Chris DeGraw--Health Resources and Services Administration
Leonard Epstein--Health Resources and Services Administration
Reem Ghandour--Health Resources and Services Administration
Seiji Hayashi--Health Resources and Services Administration
Sarah Linde-Feucht--Health Resources and Services Administration
Michael Lu--Health Resources and Services Administration
Samantha Meklir--Health Resources and Services Administration
Andrew Roszak--Health Resources and Services Administration
Mary Wakefield--Health Resources and Services Administration
John Seibel--HealthInsight New Mexico
Juliana Preston--HealthInsight Utah
Beth Averbeck--HealthPartners
David Gesko--HealthPartners
George Isham--HealthPartners
Thomas Kottke--HealthPartners
Thomas Von Sternberg--HealthPartners
Rick Luetkemeyer--HealthStrategy
Leslie Kelly Hall--Healthwise
Diane Limbo--Healthy Smiles for Kids of Orange County
John Pellicone--Helen Hayes Hospital
William Conway--Henry Ford Health System
Vanita Pindolia--Henry Ford Health System
Elizabeth Gilbertson--HEREIU Welfare Fund
Mary Blank--Highmark
Rubin Cohen--Hofstra University School of Medicine
June Lunney--Hospice and Palliative Nurses Association
Gail Austin Cooney--Hospice of Palm Beach County/Spectrum Health Inc.
Hayley Burgess--Hospital Corporation of America
Edward Septimus--Hospital Corporation of America
Louis Hoccheiser--Humana Inc.
Thomas James--Humana Inc.
Thomas James--Humana Inc.
Bryan Loy--Humana Inc.
Charles Stemple--Humana Inc.
Fredrik Tolin--Humana Inc.
Kyu Rhee--IBM
Mary Driscoll--Illinois Department of Public Health
Richard Snyder--Independence Blue Cross
Steve Udvarhelyi--Independence Blue Cross
Christopher Lamer--Indian Health Service
Steven Counsell--Indiana University School of Medicine
Floyd Fowler--Informed Medical Decision Making Foundation
Paula Graling--Inova Fairfax Hospital
Donald Goldmann--Institute for Healthcare Improvement
Sue Gullo--Institute for Healthcare Improvement
David Radley--Institute for Healthcare Improvement
Matthew Grissinger--Institute for Safe Medication Practices
Christina Michalek--Institute for Safe Medication Practices
Dolores Yanagihara--Integrated Healthcare Association
Allison Jackson--Intel
Barbara McCann--Interim HealthCare Inc.
Elizabeth Hammond--Intermountain Healthcare
Laura Heerman Langford--Intermountain Healthcare
Teri Kiehn--Intermountain Healthcare
Caterina Lasome--iON Informatics, LLC
Bob Russell--Iowa Department of Public Health
Meg Nugent--Iowa Healthcare Collaborative
Lance Roberts--Iowa Healthcare Collaborative
Nancy Zionts--Jewish Healthcare Foundation
Lisa Tripp--John Marshall Law School
Colleen Barry--Johns Hopkins Health System
Cynthia Boyd--Johns Hopkins Health System
Bruce Leff--Johns Hopkins Health System
Christoph Lehmann--Johns Hopkins Health System
Matthew McNabney--Johns Hopkins Health System
Robert Miller--Johns Hopkins Health System
Aaron Milstone--Johns Hopkins Health System
Lori Paine--Johns Hopkins Health System
Albert Wu--Johns Hopkins Health System
Patricia Abbott--Johns Hopkins University School of Nursing
David Domann--Johnson & Johnson Health Care Systems, Inc.
Christina Farup--Johnson & Johnson Health Care Systems, Inc.
Andy Amster--Kaiser Permanente
Amy Compton-Phillips--Kaiser Permanente
Douglas Corley--Kaiser Permanente
Sue Elam--Kaiser Permanente
Jamie Ferguson--Kaiser Permanente
Helen Lau--Kaiser Permanente
David Magid--Kaiser Permanente
Helene Martel--Kaiser Permanente
Ted Palen--Kaiser Permanente
David Pating--Kaiser Permanente
Elizabeth Paxton--Kaiser Permanente
Michael Schatz--Kaiser Permanente
Matt Stiefel--Kaiser Permanente
Jim Bellows--Kaiser Permanente
Jann Dorman--Kaiser Permanente
Elizabeth McGlynn--Kaiser Permanente
Lynn Searles--Kansas Department of Health and Environment
A.M. Barrett--Kessler Foundation
Bruce Pomeranz--Kessler Institute for Rehabilitation
Sean Muldoon--Kindred Healthcare
Laura Linebach--LA Care Health Plan
Rocco Ricciardi--Lahey Clinic Medical Center
Suma Thomas--Lahey Clinic Medical Center
Lauren Murray--Lamaze International
Paul Casale--Lancaster General Hospital
Cheryl Phillips--LeadingAge
Ian Chuang--Lockton Companies, LLC
Rebekah Gee--LSU School of Public Health
Anne Flanagan--Maine Department of Health
Elizabeth Mitchell--Maine Health Management Coalition
Ted Rooney--Maine Quality Counts
Scott Berns--March of Dimes
Cynthia Pellegrini--March of Dimes
Amit Acharya--Marshfield Clinic
Renee Webster--Maryland Department of Health
Elizabeth Daake--Massachusetts Department of Health
Joseph Betancourt--Massachusetts General Hospital
Liliana Bordeianou--Massachusetts General Hospital
Raymond Chung--Massachusetts General Hospital
Timothy Ferris--Massachusetts General Hospital
Elizabeth Mort--Massachusetts General Hospital
Laura Riley--Massachusetts General Hospital
Laura Riley--Massachusetts General Hospital
Karen Sepucha--Massachusetts General Hospital
David Shahian--Massachusetts General Hospital
[[Page 46725]]
David Torchiana--Massachusetts General Physicians Organization
David Polakoff--MassHealth
Robert Cima--Mayo Clinic
Pamela Foster--Mayo Clinic
Raymond Gibbons--Mayo Clinic
Catherine Roberts--Mayo Clinic
Eric Tangalos--Mayo Clinic
Karlene Phillips--Mayo Clinic
Gary Wingrove--Mayo Clinic
Charles Denk--MCH Epidemiology Program
Ginny Meadows--McKesson Corporation
Caroline Doebbeling--MDwise
Nicholas Sears--MedAssets, Inc.
Linus Santo Tomas--Medical College of Wisconsin
Peter Havens--Medical College of Wisconsin and Froedtert Hospital
Dana King--Medical University of South Carolina
Gail Stuart--Medical University of South Carolina
Zahid Butt--Medisolv, Inc.
Charlotte Alexander--Memorial Hermann Healthcare System
Roy Beasley--Memorial Hermann Healthcare System
M. Michael Shabot--Memorial Hermann Healthcare System
Lourdes Cuellar--Memorial Hermann Healthcare System--TIRR
David Pfister--Memorial Sloan-Kettering Cancer Center
Cristie Travis--Memphis Business Group on Health
Luther Clark--Merck & Co., Inc
Jennifer Bailit--MetroHealth Medical Center
Robin Shivley--Michigan Department of Health, EMS, and Trauma Systems
Michael O'Toole--Midwest Heart Specialists, Ltd.
Collette Pitzen--Minnesota Community Measurement
Diane Rydrych--Minnesota Department of Health
Vallire Hooper--Mission Hospital
Karen Fields--Moffitt Cancer Center
Jason Adelman--Montefiore Medical Center
Daniel Labovitz--Montefiore Medical Center
Helen Haskell--Mothers Against Medical Error
Leslie Zun--Mount Sinai Hospital
Peter Elkin--Mount Sinai Medical Center
R. Sean Morrison--Mount Sinai School of Medicine
Sean Morrison--Mount Sinai School of Medicine
Andrew Snyder--National Academy for State Health Policy
Gail Hunt--National Alliance for Caregiving
David Stevens--National Association of Community Health Centers
Robert Pestronk--National Association of County & City Health Officials
Denise Love--National Association of Health Data Organizations
Jane Hooker--National Association of Public Hospitals and Health
Systems
Vickie Sears--National Association of Public Hospitals and Health
Systems
Bruce Siegel--National Association of Public Hospitals and Health
Systems
Jill Steinbruegge--National Association of Public Hospitals and Health
Systems
Joan Zlotnik--National Association of Social Workers
Charles Moseley--National Association of State Directors of
Developmental Disabilities Services
Martha Roherty--National Association of States United for Aging and
Disabilities
Colleen Bruce--National Business Coalition on Health
Andrew Webber--National Business Coalition on Health
Dennis White--National Business Coalition on Health
Penney Berryman--National Business Group on Health
Helen Darling--National Business Group on Health
Pamela Kalen--National Business Group on Health
Sarah Brown--National Campaign to Prevent Teen and Unplanned Pregnancy
Steven Clauser--National Cancer Institute
Suzanne Heurtin-Roberts--National Cancer Institute
Linda Kinsinger--National Center for Health Promotion and Disease
Prevention
Carol Allred--National Coalition for Women with Heart Disease
Mary Barton--National Committee for Quality Assurance
Margaret O'Kane--National Committee for Quality Assurance
Aldo Tinoco--National Committee for Quality Assurance
Phyllis Torda--National Committee for Quality Assurance
Michael Lardiere--National Council for Community Behavioral Healthcare
Nancy Whitelaw--National Council on Aging
Howard Kirkwood--National EMS Management Association
Keith Mason--National Forum for Heart Disease and Stroke Prevention
Brad Finnegan--National Governors Association
Marcia Thomas-Brown--National Health IT Collaborative for the
Underserved
Leonardo Cuello--National Health Law Program
Deborah Reid--National Health Law Program
Mara Youdelman--National Health Law Program
Elena Rios--National Hispanic Medical Association
Carol Spence--National Hospice and Palliative Care Organization
Charles Homer--National Initiative for Children's Healthcare Quality
Jennifer Ustianov--National Initiative for Children's Healthcare
Quality
Michael Lauer--National Institutes of Health
Marcel Salive--National Institutes of Health
Salina Waddy--National Institutes of Health
Adam Burrows--National PACE Association
Peter Schmidt--National Parkinson Foundation, Inc.
Tanya Alteras--National Partnership for Women & Families
Christine Bechtel--National Partnership for Women & Families
Debra Ness--National Partnership for Women & Families
Lee Partridge--National Partnership for Women & Families
Eva Powell--National Partnership for Women & Families
Kalahn Taylor-Clark--National Partnership for Women & Families
Janet Corrigan--National Quality Forum
Floyd Eisenberg--National Quality Forum
Laura Miller--National Quality Forum
Brock Slabach--National Rural Health Association
Robert Robin--Native Americans for Community Action, Inc.
Kathryn Blake--Nemours Foundation
Stephen Lawless--Nemours Foundation
Raj Sheth--Nemours Foundation
Mary Ann Clark--Neocure Group
Harold Miller--Network for Regional Healthcare Improvement
Bobbette Bond--Nevada Healthcare Policy Group LLC
Jay Kvam--Nevada State Health Division
Jose Montero--New Hampshire Department of Health and Human Services
Christine Stearns--New Jersey Business & Industry Association
Margaret Lumia--New Jersey Department of Health and Senior Services
David Knowlton--New Jersey Health Care Quality Institute
Ann Marie Sullivan--New York City Health and Hospitals Corporation
Eliot Lazar--New York Presbyterian Healthcare System
Harold Pincus--New York Presbyterian Healthcare System
Hussein Tahan--New York Presbyterian Healthcare System
Foster Gesten--New York State Department of Health
[[Page 46726]]
Norman Otsuka--New York University Hospital for Joint Diseases
Madeline Naegle--New York University, American Nurses Association
J. Emilio Carrillo--New York-Presbyterian Community Health Plan
Scott MacLean--Newton-Wellesley Hospital
Gregory Kapinos--North Shore-Long Island Jewish Health System
Louis Potters--North Shore-Long Island Jewish Health System
Kristofer Smith--North Shore-Long Island Jewish Health System
Jeffrey Susman--Northeast Ohio Medical University
William Rich--Northern Virginia Ophthalmology Associates
David Baker--Northwestern University
Romana Hasnain-Wynia--Northwestern University
David Stumpf--Northwestern University
Jane Sullivan--Northwestern University Feinberg School of Medicine
Mark Williams--Northwestern University Feinberg School of Medicine
Mary Jean Schumann--Nursing Alliance for Quality Care
Russell Leftwich--Office of eHealth Initiatives, State of Tennessee
Frank Johnson--Office of Employee Health & Benefits, State of Maine
Stephanie Mika--Office of the Assistant Secretary for Planning &
Evaluation, HHS
Thomas Tsang--Office of the Governor, Hawaii
Jesse James--Office of the National Coordinator for Health Information
Technology
Kevin Larsen--Office of the National Coordinator for Health Information
Technology
Jacob Reider--Office of the National Coordinator for Health Information
Technology
Joshua Seidman--Office of the National Coordinator for Health
Information Technology
Allen Traylor--Office of the National Coordinator for Health
Information Technology
Kaliyah Shaheen--Ohio Department of Health
Bernadette Melnyk--Ohio State University
Susan Moffatt-Bruce--Ohio State University
Michael Sayre--Ohio State University
Patrick Ross--Ohio State University Comprehensive Cancer Center--James
Cancer Hospital
Gerene Bauldoff--Ohio State University, School of Nursing
Douglas Nee--OptiMed,Inc.
Mark Leenay--OptumHealth
Michael Lieberman--Oregon Health and Sciences University
Sydney Edlund--Oregon Patient Safety Commission
Roger Herr--Outcome Concept Systems
Kate Chenok--Pacific Business Group on Health
Emma Hoo--Pacific Business Group on Health
David Hopkins--Pacific Business Group on Health
Jennifer Huff--Pacific Business Group on Health
William Kramer--Pacific Business Group on Health
Seena Haines--Palm Beach Atlantic University
Paul Tang--Palo Alto Medical Foundation
Sue Pickens--Parkland Health & Hospital System
Michael Mirro--Parkview Health
Blackford Middleton--Partners HealthCare System, Inc.
Jason Spangler--Partnership for Prevention
Lori Frank--Patient Centered Outcomes Research Institute
Marci Nielsen--Patient Centered Primary Care Collaborative
Ron Stock--PeaceHealth Oregon Region
Chris Snyder--Peninsula Regional Medical Center
Peter Dillon--Penn State Hershey Medical Center
Michael Doering--Pennsylvania Patient Safety Authority
Eileen Kennedy--Pepco Holdings, Inc
Michael Ibara--Pfizer
Eleanor Perfetto--Pfizer
Laura Cranston--Pharmacy Quality Alliance
Kathleen Brady--Philadelphia Department of Public Health
Tina Cronin--Piedmont Medical Center
Susan Frampton--Planetree
Michael Lepore--Planetree
Richard Bankowitz--Premier healthcare alliance
Gina Pugliese--Premier healthcare alliance
Dennis Kaldenberg--Press Ganey Associates
Larry Cohen--Prevention Institute
James Lee--Providence Everett Medical Center
Robert Hellrigel--Providence Health & Services
Ron Bialek--Public Health Foundation
Mary Pittman--Public Health Institute
Louis Diamond--QHC Advisory Group, LLC
Dawn Fitzgerald--Qsource
Sharon Hibay--Quality Insights of Pennsylvania
Bonnie Paris--Quality Quest for Health of Illinois
David Seidenwurm--Radiological Associates of Sacramento Medical Group,
Inc.
Leona Cuttler--Rainbow Babies and Children's Hospital
Arthur Kellermann--RAND Corporation
Debra Saliba--RAND Corporation
Kathleen Aller--Recommind, Inc.
Mary Van de Kamp--RehabCare
Darlene Skorski--Rhode Island Department of Health--Office of
Facilities Regulation
David Krol--Robert Wood Johnson Foundation
Carey Smoak--Roche Laboratories, Inc.
Stephen Edge--Roswell Park Cancer Institute
Kathleen Lohr--RTI International
Ruth Kleinpell--Rush University Medical Center
Shannon Sims--Rush University Medical Center
Victoria Nahum--Safe Care Campaign
James Dunford--San Diego Fire-Rescue
Paul Merguerian--Seattle Children's Hospital
Rita Mangione-Smith--Seattle Children's Research Institute
Charissa Raynor--Service Employees International Union
Dale Shaller--Shaller Consulting Group
Karen Nielsen--Siemens Medical Solutions USA
J. Marc Overhage--Siemens Medical Solutions USA
Christopher Smiley--Smiley Family Dentistry, PC
Richard Bringewatt--SNP Alliance
William Grobman--Society for Maternal-Fetal Medicine
Kate Menard--Society for Maternal-Fetal Medicine
Mitchell Levy--Society of Critical Care Medicine
Janet Nagamine--Society of Hospital Medicine
Wendy Nickel--Society of Hospital Medicine
Howard Barnebey--Specialty Eyecare Centre
Jerad Widman--Spring Hill Family Medicine
Dennis Rivenburgh--St Anthony's
Mohamad Fakih--St. John Hospital and Medical Center
Kathleen Rice Simpson--St. John's Mercy Health Care
Joseph Laver--St. Jude Children's Research Hospital
Louise Probst--St. Louis Area Business Health Coalition
Mark Sanz--St. Patrick Hospital
Risha Gidwani--Stanford University Medical Center
John Morton--Stanford University Medical Center
Marc Leib--State of Arizona Medicaid Program
Ruth Leslie--State of New York Department of Health
John Maese--Staten Island University Hospital
[[Page 46727]]
Bruce Auerbach--Sturdy Memorial Hospital
Amina Chaudhry--Substance Abuse and Mental Health Services
Administration
Frances Cotter--Substance Abuse and Mental Health Services
Administration
Pamela Hyde--Substance Abuse and Mental Health Services Administration
Rita Vandivort-Warren--Substance Abuse and Mental Health Services
Administration
Thomas File--Summa Health System
Tina Picchi--Supportive Care Coalition
Lois Cross--Sutter Health
A. John Blair--Taconic IPA, Inc.
Chad Bennett--Telligen
Julie Kuhle--Telligen
Liz Johnson--Tenet Healthcare Corporation
Ann Reed--Tennessee Department of Health
William Glomb--Texas Health and Human Services Commission
Dennis Andrulis--Texas Health Institute
Steven Brotman--The Advanced Medical Technology Association
Cheryl DeMars--The Alliance
Mark McClellan--The Brookings Institute
Anne-Marie Audet--The Commonwealth Fund
Mary Jane Koren--The Commonwealth Fund
Eugene Nelson--The Dartmouth Institute
Jesse Pines--The George Washington University Medical Center
Gerard Castro--The Joint Commission
Mark Chassin--The Joint Commission
Patricia Craig--The Joint Commission
Patricia Kurtz--The Joint Commission
Jerod Loeb--The Joint Commission
Crystal Riley--The Joint Commission
Heather Sherman--The Joint Commission
Margaret VanAmringe--The Joint Commission
Ann Watt--The Joint Commission
Susan Yendro--The Joint Commission
Leah Binder--The Leapfrog Group
Barbara Rudolph--The Leapfrog Group
Nadine Gracia--The Office of Minority Health
Mady Chalk--Treatment Research Institute
Paul Conlon--Trinity Health
Tami Mark--Truven Health Analytics
Randel Johnson--U.S. Chamber of Commerce
Salma Lemtouni--U.S. Food and Drug Administration
Philip Schoenfeld--UM Medical School
Jordan Eisenstock--UMass Memorial Medical Center
Devorah Rich--United Auto Workers Retiree Medical Benefits Trust
Rhonda Robinson Beale--United Behavioral Health
Barbara Corn--UnitedHealth Group
Rhonda Medows--UnitedHealth Group
Renae Stafford--University North Carolina
Alayne Markland--University of Alabama at Birmingham
Robert Weech-Maldonado--University of Alabama at Birmingham
Doug Campos-Outcalt--University of Arizona College of Medicine
Steven Chen--University of California Davis
Francis Lu--University of California Davis
Richard White--University of California Davis
Solomon Liao--University of California Irvine
Sherrie Kaplan--University of California Irvine School of Medicine
John Kusske--University of California Irvine School of Medicine
Nasim Afsar-manesh--University of California Los Angeles
Jim Crall--University of California Los Angeles
Bonnie Zima--University of California Los Angeles Center for Health
Services & Society
Christopher Saigal--University of California Los Angeles Medical Center
Theodore Ganiats--University of California San Diego
Charlene Harrington--University of California San Francisco
Louise Walter--University of California San Francisco
Nancy Donaldson--University of California San Francisco School of
Nursing
Marshall Chin--University of Chicago
William McDade--University of Chicago
William Dale--University of Chicago Medical Center
Nancy Lowe--University of Colorado Denver
Mark Metersky--University of Connecticut Health Center
Ramon Bautista--University of Florida HSC/Jacksonville
Tim Williamson--University of Kansas Medical Center
Katherine Reeder--University of Kansas School of Nursing
Judith Warren--University of Kansas School of Nursing
Joanna Sikkema--University of Miami, School of Nursing and Health
Studies
William Barsan--University of Michigan Hospitals and Health Centers
James Carpenter--University of Michigan Hospitals and Health Centers
Elaine Chottiner--University of Michigan Hospitals and Health Centers
Curtis Collins--University of Michigan Hospitals and Health Centers
Karen Farris--University of Michigan Hospitals and Health Centers
Ella Kazerooni--University of Michigan Hospitals and Health Centers
Janet Larson--University of Michigan Hospitals and Health Centers
Jean Malouin--University of Michigan Hospitals and Health Centers
Marc Moote--University of Michigan Hospitals and Health Centers
Anne Pelletier Cameron--University of Michigan Hospitals and Health
Centers
Linda Lindeke--University of Minnesota Amplatz Children's Hospital
Ira Moscovice--University of Minnesota Rural Health Research Center
Kristi Anne Henderson--University of Mississippi Medical Center
Bonnie Wakefield--University of Missouri
John Fildes--University of Nevada Las Vegas Medical Center
Ethan Basch--University of North Carolina at Chapel Hill
Jessica Lee--University of North Carolina at Chapel Hill
Sidney Smith--University of North Carolina at Chapel Hill
David Weber--University of North Carolina at Chapel Hill
Lynn Wegner--University of North Carolina School of Medicine
Lawrence Marks--University of North Carolina, School of Medicine
Dale Bratzler--University of Oklahoma Health Sciences Center
Mark Wolraich--University of Oklahoma Health Sciences Center
Judith Hibbard--University of Oregon
Leah Marcotte--University of Pennsylvania
Brendan Carr--University of Pennsylvania Health System
Lee Fleisher--University of Pennsylvania Health System
Jerry Johnson--University of Pennsylvania Health System
Frank Leone--University of Pennsylvania Health System
David Casarett--University of Pennsylvania School of Medicine
Kathryn Bowles--University of Pennsylvania School of Nursing
Nancy Hanrahan--University of Pennsylvania School of Nursing
Therese Richmond--University of Pennsylvania, School of Nursing
Douglas White--University of Pittsburgh
Donald Yealy--University of Pittsburgh Medical Center
Carl Sirio--University of Pittsburgh School of Medicine
Heidi Donovan--University of Pittsburgh School of Nursing
[[Page 46728]]
Laurent Glance--University of Rochester
Kevin Fiscella--University of Rochester School of Medicine
Jeffrey Beal--University of South Florida
Barbara Turner--University of Texas Health Science Center at San
Antonio
Eduardo Bruera--University of Texas MD Anderson Cancer Center
Kenneth Ottenbacher--University of Texas Medical Branch at Galveston
Ethan Halm--University of Texas Southwestern Medical Center
Mambarambath Jaleel--University of Texas Southwestern Medical Center
Kathy Rinnert--University of Texas Southwestern Medical Center
Craig Rubin--University of Texas Southwestern Medical School
Victoria Jordan--University of Texas-MD Anderson Cancer Center
John Skibber--University of Texas-MD Anderson Cancer Center
Barbara Summers--University of Texas-MD Anderson Cancer Center
Ronald Walters--University of Texas-MD Anderson Cancer Center
Amy Hessel--University of Texas-MD Anderson Medical Center
Paul Glassman--University of the Pacific School of Dentistry
David Classen--University of Utah School of Medicine
Michael Farber--University of Vermont College of Medicine
Pamela Cipriano--University of Virginia Health System
Rachel Grob--University of Wisconsin Center for Patient Partnerships
Elizabeth Jacobs--University of Wisconsin, Department of Medicine
Patricia Brennan--University of Wisconsin-Madison
Tracy Schroepfer--University of Wisconsin-Madison
Christine Hunter--US Office of Personnel Management
John O'Brien--US Office of Personnel Management
Iona Thraen--Utah Department of Health
Jim Smith--Utica College
David Penson--Vanderbilt University Medical Center
W. Stuart Reynolds--Vanderbilt University Medical Center
Peter Almenoff--Veterans Health Administration
Caroline Blaum--Veterans Health Administration
John Duda--Veterans Health Administration
Stephan Fihn--Veterans Health Administration
Joseph Francis--Veterans Health Administration
Vivienne Halpern--Veterans Health Administration
Marcia Insley--Veterans Health Administration
Michael Kelley--Veterans Health Administration
Daniel Kivlahan--Veterans Health Administration
Robert Petzel--Veterans Health Administration
Patricia Quigley--Veterans Health Administration
Scott Shreve--Veterans Health Administration
Patricia Sinnott--Veterans Health Administration
Donna Washington--Veterans Health Administration
Edward Gill--Virginia Commonwealth University Medical Center
Cathie Furman--Virginia Mason Medical Center
Johannes Koch--Virginia Mason Medical Center
Jolynn Suko--Virginia Mason Medical Center
Carol Mullin--Virtua Health
Margaret Terry--Visiting Nurse Associations of America
Carol Raphael--Visiting Nurse Service of New York
Robert Rosati--Visiting Nurse Service of New York
William Frohna--Washington Hospital Center
Linda Furkay--Washington State Department of Health
David Mancuso--Washington State Department of Social & Health Services
Jeffery Thompson--Washington State Medicaid
Michael Kaplitt--Weill Cornell Medical College
Aron Halfin--WellPoint
Richard Hastreiter--WellPoint
Jennifer Malin--WellPoint
Sarah Sampsel--WellPoint
Grace Ting--WellPoint
Tracy Wang--WellPoint
Alonzo White--WellPoint
Christy Whetsell--West Virginia University Hospitals
Frank Ghinassi--Western Psychiatric Institute & Clinic of the
University of Pittsburgh Medical Center
Lori Nichols--Whatcom Health Information Network
Christopher Queram--Wisconsin Collaborative for Healthcare Quality
John Bott--Wisconsin Department of Employee Trust Funds
Lois Sater--Wisconsin Division of Public Health
Nancy Faller--Wound, Ostomy and Continence Nurses Society
Jeptha Curtis--Yale New Haven Health System
Elizabeth Drye--Yale New Haven Health System
Marcella Nunez-Smith--Yale New Haven Health System
Patrick O'Connor--Yale New Haven Health System
Mary Tinetti--Yale New Haven Health System
Patricia Button--Zynx Health
David Rhew--Zynx Health
Appendix F: National Quality Forum--Background
Despite the hard work of many, there is broad recognition that our
healthcare system can do a better job on quality, safety, and
affordability. This reality, in the context of a cost-conscious
economy, has re-energized a national commitment to simultaneously
improve care and responsibly constrain healthcare costs. State leaders,
local governments, a broad swath of federal healthcare agencies, and an
increasing number of other public- and private-sector organizations
that constitute the quality movement are at the center of that
resurgence. NQF is a public service organization that helps unite all
of these organizations in their pursuit to make healthcare better,
safer, and affordable.
Established in 1999 as the standard-setting organization for
healthcare performance measures, NQF today has a much-broadened mission
to:
Build consensus on national priorities and goals for
performance improvement, and work in partnership with the public and
private sectors to achieve them.
Endorse and maintain best-in-class standards for measuring
and publicly reporting on healthcare performance quality.
Promote the attainment of national healthcare improvement
goals and the use of standardized measures through education and
outreach programs.
NQF is recognized as a voluntary consensus standard-setting
organization under the National Technology Transfer and Advancement Act
of 1995. Its process for reaching consensus adheres to the Office of
Management and Budget's formal definition of consensus.\31\
The NQF Board of Directors governs the organization and is composed
of 31 voting members--key public- and private-sector leaders who
represent major stakeholders in America's healthcare system. Consumers
and those who purchase healthcare hold a simple majority of the at-
large seats (see Appendix B). In 2012, NQF convened more than 800
hundred experts across every stakeholder group who contributed their
time, experience, and insights to measure-review, measure-selection,
and priority-setting committees (see Appendix E).
In recent years as part of a close working partnership with HHS,
the
[[Page 46729]]
variety of NQF-endorsed measures has greatly expanded to address most
settings of care, conditions, and provider types. NQF's measure
portfolio includes measures of clinical process, patient experience of
care, the actual outcomes of care, the costs and resources that go into
providing care, as well as select structural measures. The portfolio is
being enhanced with advanced measures, such as patient-reported
outcomes and cross-cutting care-coordination measures. At the same
time, NQF carefully manages its portfolio to be lean, retiring measures
that no longer meet the more rigorous criteria. In the past year alone,
430 measures were submitted to NQF and 301, or nearly 70 percent, were
endorsed. This endorsement rate--or ratio of submitted to endorsed
measures--reflects NQF's efforts to systematically raise the bar on
performance measurement and to fill key measurement gap areas even as
it aggressively seeks to reduce the burden on providers by eliminating
duplicative measures that add unnecessary data collection and
administrative workload.
Percentage of Outcome Measures in NQF Portfolio, 2010-2012
------------------------------------------------------------------------
Percentage of
outcome
Year measures in
portfolio
------------------------------------------------------------------------
2010.................................................... 18
2011.................................................... 24
2012.................................................... 27
------------------------------------------------------------------------
To be NQF endorsed, a measure must capture a process or outcome
that is important to measure and report, be scientifically acceptable,
be feasible to collect, and provide useful results. NQF conducts an
eight-step, consensus-based process for reviewing measures and other
standards; this process has been continually improved over a decade,
and is as follows:
1. Call for Nominations allows anyone to suggest a candidate for
the committee that will oversee the project. Committees are diverse,
often encompassing experts in a particular field, providers,
scientists, and consumers. After selection, NQF posts committee rosters
on its Web site to solicit public comments on the composition of the
panel and makes adjustments as needed to ensure balanced
representation.
2. Call for Measures starts a 30-day period for developers to
submit a measure or practice through NQF's online submission forms.
3. Steering Committee Review puts submitted measures to a four-part
test to ensure they reflect sound science, will be useful to providers
and patients, and will make a difference in improving quality. The
expert steering committee conducts this detailed review in open
sessions, each of which starts a limited period for public comment.
4. Public Comment solicits input from anyone who wishes to respond
to a draft report that outlines the steering committee's assessment of
measures for possible endorsement. The steering committee may request a
revision to the proposed measures.
5. Member Vote asks NQF members to review the draft report and cast
their votes on the endorsement of measures.
6. CSAC Review marks the point at which the NQF Consensus Standards
Approval Committee (CSAC) deliberates on the merits of the measure and
the issues raised during the review process, and makes a recommendation
on endorsement to the Board of Directors. The CSAC includes consumers,
purchasers, healthcare professionals, and others. It provides the big
picture to ensure that standards are being consistently assessed from
project to project.
7. Board Ratification asks for review and ratification by the NQF
Board of Directors of measures recommended for endorsement.
8. Appeal opens a period when anyone can appeal the Board's
decision.
Review committees comprise multiple stakeholders; consumer
organizations and individual patients are equal partners with
clinicians and other stakeholders throughout the process. There is a
strong commitment to transparency: NQF invites public participation at
every step, ranging from nominations for committees to comments and
votes on specific measures. Endorsed measures are re-evaluated every
three years to ensure their continuing relevance with current science
and their actual use and usefulness in the field, and to determine
whether they continue to represent the best in class compared to new
measures. At any time, NQF can also conduct an ad hoc review of a
measure if there is evidence of unintended consequences related to
measurement or emerging clinical evidence that should result in a
change to the measure.
Measures included in the NQF portfolio are developed and maintained
by about 65 different organizations including the Centers for Medicare
and Medicaid Services (CMS), the National Committee for Quality
Assurance (NCQA), the Physician Consortium for Performance Improvement,
convened by the American Medical Association (AMA-PCPI), Ingenix, The
Joint Commission, American College of Surgeons (ACS), Bridges to
Excellence, Cleveland Clinic, Minnesota Community Measurement, and
Pharmacy Quality Alliance.
Many public- and private-sector leaders contributed to developing
NQF's multi-stakeholder consensus process in the measure-endorsement
realm. In recognition of this unique public service, HHS is required
under statute to contract with a consensus-based entity, and contracted
with NQF to convene diverse stakeholder groups to advise the public
sector on priorities for healthcare improvement, related implementation
strategies, and selection of measures to both drive these strategies
and gauge results. The NQF-convened NPP and MAP and their published
reports are tangible outcomes of this work. An equally important
outcome of these partnerships is the ongoing alignment across
stakeholder groups and across public- and private-sector leaders about
which levers are most powerful in both improving healthcare performance
and making the delivery system more patient centered.
NQF was initially funded primarily through grants from major
philanthropic foundations, including the Robert Wood Johnson Foundation
and the Commonwealth Fund. NQF in turn built a strong membership base
across all those who care about advancing healthcare quality;
membership dues continue to provide annual funding for NQF's work.
In 2012, NQF received $4.43 million a year in membership dues, an
amount equaling 18 percent of its total budget. When combined with
private foundation funding, 23 percent of NQF's budget comes from the
private sector, with the remainder of its funding stemming from the
public sector. In addition, the value of uncompensated donated time in
2012--some 55,000 hours of work done on a volunteer basis by healthcare
leaders and experts--is conservatively estimated to equal another $4
million in private funding for NQF's work. Scaling up NQF's capacity
became a necessity when the public sector, in its role as the largest
American healthcare purchaser, made a serious commitment to buying
healthcare based on value. This policy direction immediately generated
the need for a more sustainable, steady resource that stood ready to
regularly review and endorse performance measures.
NQF has been fortunate to have received support from the federal
government for more than 10 years, particularly since 2008 when federal
leaders strongly committed themselves
[[Page 46730]]
to designing and implementing a value-driven agenda for healthcare.
More specifically:
MIPPA has provided NQF with $10 million annually over a
four-year period starting in 2009, which was extended for FY 2013 by
HR8 (PL 112-240). These funds--awarded to NQF through a competitive
process--support the organization's efforts to identify priority areas
for improvement, endorse and update related performance measures,
foster the transition to an electronic environment, and report annually
to Congress on the status and progress to date of this effort.
ACA has provided NQF with support of about $10 million annually,
starting in 2011. Under Section 3014, Congress directed HHS to contract
with ``the consensus-based entity under contract'' to provide multi-
stakeholder input into the NQS, as well as input to the Secretary of
HHS on the selection of measures for use in various quality programs
that utilize the federal rulemaking process for measure selection.
IV. Secretarial Comments on the Annual Report to Congress
This 2013 Annual Report describes NQF's work in 2012 to fulfill the
requirements specified in section 1890 of the Social Security Act. This
section of the Social Security Act requires the Secretary of the
Department of Health and Human Services to ``have in effect a contract
with a consensus-based entity, such as the National Quality Forum,'' to
perform certain duties including those related to performance
measurement and NQS priorities. The Social Security Act also requires
by not later than March 1 of each year (beginning with 2009), that the
CBE shall submit to Congress and the Secretary of the Department of
Health and Human Services a report containing a description of:
(i) Implementation of quality and efficiency measurement
initiatives under the Social Security Act and the coordination of
such initiatives with quality and efficiency initiatives implemented
by other payers;
(ii) recommendations on an integrated national strategy and
priorities for health care performance measurement;
(iii) performance of its duties required under its contract with
HHS;
(iv) gaps in endorsed quality and efficiency measures, and where
quality and efficiency measures are unavailable or inadequate to
identify or address such gaps;
(v) areas in which evidence is insufficient to support
endorsement of quality and efficiency measures in priority areas
identified by the Secretary under the national strategy and where
targeted research may address such gaps; and
(vi) convening multi-stakeholder groups to provide input on: 1)
The selection of quality and efficiency measures for use in various
Medicare programs, in reporting performance information to the
public; and in other health care programs; and 2) national
priorities for improvement in population health and the delivery of
health care services for consideration under the national quality
strategy.
This 2013 report fulfills the statutory requirement for the annual
report described above and describes the results of work that NQF, as
the CBE, undertook in 2012.
For example, in 2012, NQF managed its portfolio of more than 700
endorsed measures by replacing some measures with improved measures;
removing measures that were no longer effective or where the evidence
base had evolved; and expanding the portfolio to address well-
recognized measurement gaps. NQF reviewed 430 submitted measures and
endorsed 301 of them. This set included 81 new measures and 220
measures that maintained their endorsement after being considered in
light of new evidence and/or against new competing measures submitted
to NQF for consideration. The newly endorsed measures align with needs
identified in the NQS and address several critical areas, including
patient outcomes, underserved populations, healthcare disparities, and
hospital readmissions.
In 2012, NQF's National Priorities Partnership (NPP), a
collaborative public-private partnership, focused on how to advance
patient safety by aligning its work with HHS' ``Partnership for
Patients'' initiative. Through a series of web-based and in-person
meetings, nearly 2,700 participants from multiple sectors learned about
and shared new improvement approaches, information, tools, and
professional connections to improve health care safety. The NPP also
developed action plans to focus a range of national and local
organizations in diverse sectors on how to align efforts to reduce
preventable readmissions and improve maternity care, and created a web-
based ``action registry'' to track improvement activities focused on
readmissions and maternity care to enable learning across participants.
Launched in the fourth quarter of 2012, by March 2013, the registry
housed over 50 actions by 30 different organizations.
In 2012, NQF also continued its work to facilitate the electronic
reporting of quality measures using electronic health records (EHRs)
that health care providers across the nation are adopting. NQF's work
on these ``eMeasures'' included standardizing data elements so the same
quality of care information can be collected from different EHRs. NQF
also convened an eMeasure Learning Collaborative to help multiple
parties address barriers to developing and implementing eMeasures.
NQF's Measure Applications Partnership (MAP) provided multi-
stakeholder input to HHS about the potential use of quality measures in
more than 17 different Medicare quality reporting and performance
programs and the Medicare and Medicaid Electronic Health Record (EHR)
Incentive Program. This input was critical to HHS programs. At the same
time, MAP released its Families of Measures report, which defined
measure families in four key areas--safety, care coordination,
cardiovascular, and diabetes care--with the goal of promoting more
cohesion and integration of care regardless of setting, provider, level
of care intensity, or timing of care.
In 2012, NQF also conducted an analysis of its current measures
portfolio against both the NQS priority areas and high-impact Medicare
and child health conditions. This analysis found that while many NQF
measures address patient safety, fewer measures address patient and
family engagement. For example, measures of shared decision-making,
patient navigation and self-management, healthy lifestyle behaviors,
community interventions to improve health, and access, cost, and
resource use are significantly less prevalent than safety measures. The
analysis also found gaps in measures of preventive care, patient-
reported outcomes (particularly quality of life and functional status),
appropriateness (particularly for specialty care), access to timely
palliative care, and health and healthcare disparities. Additionally,
the analysis revealed the need for better population-level measures to
assess improvements in health and healthcare. And, while certain high-
impact conditions common to adults have an abundance of measures--e.g.,
cardiovascular disease, end-stage renal disease, and diabetes--many of
the high-impact childhood conditions have few or no NQF-endorsed
measures.
These and the other activities described in the Annual Report
reflect the wide scope of work required for sound measurement of health
care quality--and the accompanying hard work needed for the continued
improvement of health care. HHS thanks NQF for its hard work and
submission of this report.
[[Page 46731]]
V. Future Steps
The work reflected in this annual report was produced under HHS'
initial four-year contract to NQF which was executed in 2009 and will
expire in 2013.
To continue to fulfill the statutory requirement for a contract
with a consensus-based entity, HHS competitively procured a new
contract with NQF in September 2012. Through this new contract, NQF
will continue to perform the statutory activities for the CBE described
above in support of HHS' efforts to achieve the aims of the NQS--
better care, healthier people and communities, and affordable care.
VI. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995 (44 U.S.C. 35)
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Dated: July 25, 2013.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
[FR Doc. 2013-18478 Filed 7-31-13; 8:45 am]
BILLING CODE 4150-05-P