[Federal Register Volume 74, Number 174 (Thursday, September 10, 2009)]
[Notices]
[Pages 46594-46603]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-21783]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
[HHS-XXXX-N]
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.
-----------------------------------------------------------------------
SUMMARY: This notice acknowledges 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
regarding performance measurement as mandated by section 183 of the
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The statute requires HHS to publish not later than six months after
receiving the annual report to Congress in the Federal Register
together with any Secretarial comments.
FOR FURTHER INFORMATION CONTACT: Patrick Conway, (202) 690-7858.
I. Background
Rising health care costs coupled with the growing concern over the
level and variation in quality and efficiency in the provision of
health care raise important challenges for the United States. Congress
mandated the Secretary of the Department of Health and Human Services
(HHS) to contract with a consensus-based entity regarding performance
measurement to support HHS' efforts to achieve value as a purchaser of
high-quality, patient-centered, and financially sustainable health
care. Section 183 of the Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA) added section 1890 to the Social Security
Act (the Act). The statute mandates that the contract shall be
competitively awarded for a period four years and may be renewed under
a subsequent competitive contracting process.
In January 2009, the competitive contract was awarded by HHS to the
National Quality Forum (NQF) for a four year period. With respect to
the scope of the HHS contract activities, NQF shall conduct its
business in an open and transparent manner, provide the opportunity for
public comment and ensure membership fees do not pose a barrier to
participation in the scope of HHS' contract activities, if applicable.
The HHS four-year contract with NQF includes the following major
tasks:
Formulation of National Strategy and Priorities for Health Care
Performance Measurement--NQF shall synthesize evidence and convene key
stakeholders on the formulation of an integrated national strategy and
priorities for health care performance measurement in all applicable
settings. NQF shall give priority to measures: That address the health
care provided to patients with prevalent, treatment of 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.
NQF shall consider measures that 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.
Implementation of a Consensus Process for Endorsement of Health
Care Quality Measures--NQF shall implement a consensus process for
endorsement of standardized health care performance measures which
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 providers including hospitals and physicians.
Maintenance of Consensus Endorsed Measures--NQF shall establish and
implement a maintenance process to ensure that endorsed measures are
updated (or retired if obsolete) as new evidence is developed.
Promotion of Electronic Health Records--NQF shall promote the
development and use of electronic health records that contain the
functionality for automated collection, aggregation, and transmission
of performance measurement information.
Focused Measure Development, Harmonization, and Endorsement Efforts
to Fill Critical Gaps in Performance Measurement--At the request and
direction of HHS, NQF shall complete targeted tasks to support
performance measurement development, harmonization, endorsement and/or
gap analysis.
Development of a Public Web site for Project Documents--NQF shall
develop a public Web site to provide access to project documents and
processes. The HHS contract work is found at: http://www.qualityforum.org/projects/ongoing/hhs/.
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), NQF shall submit to Congress and the Secretary
of HHS an annual report. The report shall contain a description of the
implementation of quality measurement initiatives under the Act and the
coordination of such initiatives with quality initiatives implemented
by other payers; a summary of activities and recommendations from the
national strategy and priorities for health care performance
measurement task; and a discussion of performance by NQF of the duties
required under the HHS contract. Due to the award of the contract to
NQF in mid January 2009, the first annual report covers the performance
period of January 14, 2009 to February 28, 2009.
In March 2009, NQF submitted the annual report to Congress and the
Secretary of HHS. Section 1890(b)(5)(B) of the Social Security Act, as
created by section 183 of MIPPA, requires the Secretarial review of the
annual report to Congress upon receipt and the publication of the
report in the Federal Register together with any Secretarial comments
not later than 6 months after receiving the report. This notice
complies with the review and publication requirements of the statutory
mandate.
First NQF Report to Congress and HHS Secretary
Submitted in March 2009, the first annual report to Congress and
the Secretary spans the period of January 14, 2009 to February 28,
2009. The first annual report reflects six weeks post contract award.
Given the short timeframe between the contract award and the
requirement for the annual report, it reflects a description of the NQF
work-to-date as of March 2009 and future plans to comply with the
schedule of deliverables. Additional
[[Page 46595]]
time under the contract will provide NQF the opportunity to report on
its specific activities and deliverables provided to HHS in the next
annual report and future annual reports. A copy of NQF's submission of
the March 2009 annual report to Congress and the Secretary of HHS can
be found at: http://www.qualityforum.org/projects/ongoing/hhs. The NQF
annual report is reproduced in section III of this notice.
II. NQF March 2009 Annual Report
Improving Health Care Performance:
Setting Priorities and Enhancing Measurement Capacity
Report to Congress and the Secretary of the U.S. Department of
Health and Human Services
Covering the Period of January 14, 2009 to February 28, 2009
The mission of the National Quality Forum is to improve the quality
of American health care by setting national priorities and goals for
performance improvement, endorsing national consensus standards for
measuring and publicly reporting on performance, and promoting the
attainment of national goals through education and outreach programs.
Section 183 of the Medicare Improvements for Patients and Providers
Act of 2008 (MIPPA) mandates a Department of Health and Human Services
(HHS) contract with a consensus-based entity regarding performance
measurement (Section 1890 of the Social Security Act (the Act)). The
National Quality Forum (NQF) was awarded the HHS contract through a
competitive contracting mechanism to serve as the consensus-based
entity. The statute mandates the submission of an annual report to both
Congress and the Secretary of Health and Human Services by the
consensus-based entity awarded the HHS contract (Section 1890(b)(5)(A)
of the Act). The statute specifically requires the Secretarial review
of such report upon receipt and the publication of such report in the
Federal Register together with any Secretarial comments not later than
6 months after receiving the report (Section 1890(b)(5)(B) of the Act).
This report was prepared by NQF. The report does not necessarily
reflect the views of HHS. All HHS comments on this report will be
provided at the time of its publication in the Federal Register. This
report is part of contract number HHSM-500-2009-00010C. National
Quality Forum, 601 Thirteenth Street, NW., Suite 500 North, Washington,
DC 20005, Fax 202-783-3434, http://www.qualityforum.org.
Executive Summary
There is widespread and growing awareness from all levels of
government that health care reform is a critical component of economic
recovery--and that reform must address health care quality, safety,
costs, access, and disparities in care. Truly better quality of care--
care that is more effective, safe, and efficient--is an imperative for
aiding our nation's economic recovery and making good on our commitment
to cover the uninsured.
Numerous efforts are under way to advance the quality improvement
agenda. These include the pay-for-performance and pay-for-reporting
initiatives being undertaken by public and private sector purchasers;
public reporting of performance information by the Centers for Medicare
& Medicaid Services (CMS), State governments, and others; quality
oversight by regulatory, accreditation, and professional certification
bodies; and quality improvement activities being conducted by CMS'
quality improvement organizations (QIOs), End-Stage Renal Disease
Network Organizations, health care providers, practitioners, and
others.
The overarching goal of all of our work is to improve the quality
and affordability of health care by providing information to consumers
and others to assist them in making more informed health care
decisions, and to providers and practitioners to drive quality
improvement. Measuring health care performance and then sharing those
results with those who provide services and those who purchase and
receive them are the cornerstones of a system that fosters not just
incremental gains, but continued large-scale quality improvement.
Performance information is needed to support quality improvement,
reform payment programs to promote value, and engage patients in making
better choices and managing their health conditions. Performance
measurement is a key building block for improving the quality of care.
Recognizing the need to strengthen the nation's performance
measurement capacity, Congress included a provision within the Medicare
Improvements for Patients and Providers Act of 2008 (PL 110-275),
directing the Secretary of the Department of Health and Human Services
(DHHS) to contract with a ``consensus-based entity, such as the
National Quality Forum.'' The entity shall:
Synthesize evidence and convene key stakeholders to make
recommendations, with respect to activities conducted under this Act,
on an integrated national strategy and priorities for health care
performance measurement in all applicable settings.
Provide for the endorsement of standardized health care
performance measures.
Establish and implement a process to ensure that measures
endorsed are updated (or retired if obsolete) as new evidence is
developed.
Promote the development and use of electronic health
records that contain the functionality for automated collection,
aggregation, and transmission of performance measurement information.
Submit an annual report to Congress and the Secretary.
Under the contract, DHHS has asked that measures focus on
``outcomes and efficiencies that matter to patients, align with
electronic collection at the front end of care, encompass episodes of
care when possible, and be attributable to providers where possible. A
premium must be placed on developing measures in key areas that will
have the greatest impact in improving quality and value, rather than
focusing on developing a large number of measures that may be easiest
to produce, such as process measures.'' On January 14, 2009, the
National Quality Forum (NQF) was awarded a contract that addresses and
is responsive to Section 183 of the Medicare Improvements for Patients
and Providers Act of 2008. The contract, which has a period of
performance of four years, is being incrementally funded on a yearly
basis.
As a part of its work under the contract, NQF is required to
produce an Annual Report to Congress by March 1 each year. Because this
contract only recently commenced on January 14, 2009, this initial
report to Congress provides a ``look forward.'' More specifically, it
focuses on two areas:
Recent accomplishments that provide a foundation for work
under this contract, and
Strategic direction and key challenges that lie ahead.
Foundation for Work: Background and Recent Accomplishments
NQF is a not-for-profit, multi-stakeholder membership organization
whose mission is to improve the quality of American health care by:
Setting national priorities and goals for performance
improvement;
Endorsing national consensus standards for measuring and
publicly reporting on performance, and on promoting the attainment of
national goals through education and outreach programs.
[[Page 46596]]
NQF's membership includes more than 375 organizations representing
virtually every sector of the health care system. The work to be
conducted under this DHHS contract will directly relate to NQF's core
competencies and recent accomplishments in three areas:
Setting National Priorities and Goals. NQF has convened
leaders from major stakeholder groups and through this process has
identified National Priorities and Goals for Performance Improvement.
This work provides a foundation for the priority-setting efforts under
this contract which focus on clinical conditions.
Endorsing performance measures. NQF's consensus
development process has resulted in more than 400 endorsed measures.
Facilitating the development of electronic health records
to support measurement and improvement. NQF has worked to identify the
types of information that need to be included in an EHR to enable
reporting on quality metrics.
Setting National Priorities and Goals
The National Priorities Partnership, convened by NQF, is a
collaborative effort of 28 major national organizations representing
multiple stakeholders, including consumer groups, employers,
government, health plans, health care organizations, health care
professionals, accrediting and certifying bodies, and quality
alliances. The Partnership set National Priorities and Goals intended
to focus performance improvement efforts on high-leverage areas--those
with the most potential in the near term to result in substantial
improvements in health and health care--and thus accelerate fundamental
change in our health care delivery system. Taking action on the high-
leverage Priorities and Goals, the Partners, individually and
collectively, have the capacity to significantly advance health care
reform. In November 2008, the Partnership released the results of its
initial work in a report: National Priorities and Goals: Aligning our
Efforts to Transform America's Health Care (see Appendix A for the
executive summary).
The National Priorities and Goals were selected because they
address four major challenges: Eliminating harm, eradicating
disparities, reducing disease burden, and eliminating waste. The
National Priorities fall into six areas:
Engage patients and families in managing their health and
making decisions about their care.
Improve the health of the population.
Improve the safety and reliability of America's health
care system.
Ensure patients receive well-coordinated care within and
across all health care organizations, settings, and levels of care.
Guarantee appropriate and compassionate care for patients
with life-limiting illnesses.
Eliminate overuse while ensuring the delivery of
appropriate care.
The Partners are now developing action plans to achieve the
National Priorities and Goals, which will entail alignment of key
environmental drivers, such as public reporting, payment, and
accreditation and certification programs. Learn more at http://www.nationalprioritiespartnership.org.
Endorsing Performance Measures
Advancing quality improvements requires valid, meaningful
measurement. Simply put, you cannot improve what you cannot measure.
Measures make it possible to more effectively focus our quality
improvement efforts by helping identify what is working and what needs
additional improvement. NQF is a private sector, standard-setting
organization, and one of its roles is to evaluate measures and select
the ``best in class.'' Use of NQF-endorsed[supreg] measures facilitates
making apples-to-apples comparisons.
NQF is a voluntary consensus standard-setting organization as
defined by the National Technology Transfer and Advancement Act of 1995
(NTTAA) and the Office of Management and Budget Circular A-119.
Standard-setting organizations recognized under NTTAA must comply with
strict requirements pertaining to multi-stakeholder involvement,
transparency of decisionmaking, and due process.
The consensus development process (CDP) is the formal process by
which NQF achieves consensus and endorses measures. There are seven
steps in the endorsement process: Formation of a steering committee,
calls for measures, measure evaluation, public comment, member voting,
review by the consensus standards approval committee and board of
directors, and appeals. The CDP reflects a careful process designed to
produce consensus from disparate groups across the health care
industry, including consumers, purchasers, providers, public and
community health, suppliers, quality improvement and measurement
organizations, and health plans.
Using this process, NQF has endorsed more than 400 quality measures
for a variety of health care settings.
In 2008, NQF conducted consensus development projects in the
following areas:
Perinatal Care;
Home Health Care;
Ambulatory Care;
Emergency Care;
Health Information Technology;
Hospital Care;
Immunization;
Outpatient Imaging.
Much of the support for these projects was provided by CMS and the
Agency for Health care Research and Quality (AHRQ), as well as private
foundations.
Facilitating the Development of Electronic Health Records To Support
Measurement and Improvement
NQF also serves as an important ``bridge'' between the quality and
health information technology communities to facilitate the development
of electronic health records (EHRs) and personal health records (PHRs)
that are capable of supporting performance measurement, reporting, and
improvement. That work has two objectives. First, performance measures
need to have turnkey measurement specifications that allow ready
incorporation directly into EHRs and PHRs. Second, EHRs and PHRs must
be able to capture the necessary data and possess the necessary
functionality to calculate and report the performance information and
provide the associated clinical decision-support to practitioners to
improve performance.
NQF's Health Information Technology Expert Panel (HITEP), funded
with support from AHRQ, produced its first report in January 2009
Recommended Common Data Types and Prioritized Performance Measures for
Electronic Health Care Information Systems (see Appendix B for the
executive summary). This report identifies the types of data that must
be captured in EHRs to calculate the performance measures that are
currently used by Medicare for public reporting purposes. Through its
measure endorsement process, NQF is working with measure developers to
encourage the adoption of common conventions for specifying measures
that will make it easier for vendors to build EHRs and PHRs capable of
calculating the measures and providing the associated clinical
decision-support to assist providers in improving their performance.
HITEP is now working closely with the DHHS Office of the National
Coordinator to ensure that the ``Quality Data Set''--the types of data
that need to be captured in EHRs and PHRs to support quality
measurement and performance improvement--gets translated into health
information technology standards, which in turn
[[Page 46597]]
become requirements for EHR certification by the Certification
Commission for Health Information Technology.
Strategic Direction and Challenges Ahead
NQF has for many years received federal support, primarily in the
form of grants and contracts for very specific projects (e.g., a
project to review physician-level measures related to cancer care).
This new DHHS contract supports development and execution of a
comprehensive, multi-year work plan for performance measurement. This
contract will bolster, very significantly, six key functions of the
quality measurement infrastructure.
Further Enhance the National Priorities and Goals. The current set
of National Priorities and Goals represents cross-cutting areas that
apply to all or many patients and conditions, like safety and care
coordination. Over the coming year, a prioritized list will be
developed of the top 20 conditions that account for 90 percent of
Medicare costs, based on various criteria, including health and cost
burden and opportunity for improvement. This two-dimensional
framework--cross-cutting areas and conditions--will be used to focus
the work of both NQF and other key players to achieve rapid
improvement.
Building Measure Sets for Patient-Focused Episodes. Over the coming
two to three years, measure sets will be identified for each of the top
20 conditions that include measures of the health care process (e.g.,
effectiveness and safety measures), patient engagement, in decision
making, patient outcomes, and cost. This framework moves the
measurement field from a focus on the provision of individual services
provided in one setting to an ``episode'' view that fosters patient
engagement care coordination, efficiency, and accountability for
outcomes.
Identify Critical Gaps in Measures. Measures will be needed to
gauge progress in meeting the National Priorities and Goals, and
efforts are now under way to identify gaps in the portfolio of NQF-
endorsed measures. The mapping of available measures to conditions/
patient-focused episodes will also reveal gaps.
Identify Areas for New Measure Development. Based on the ``gap
analysis'' discussed above, an environmental scan will be conducted to
determine if measures are available for endorsement or whether new ones
need to be developed and which measures may be of most importance to
the Medicare, Medicaid, or CHIP populations. There is also a
significant need to identify where composite measures (combinations of
two or more individual measures to produce an overall score) should be
developed to provide an overall indication of performance in particular
areas (e.g., preventive services, safety).
Measure Maintenance and Retooling. The ability to examine measures
on an ongoing basis with built-in requirements for regular measure
maintenance helps ensure that the best measures are available for
public reporting, health care performance assessment, and quality
improvement. Performance measures must be maintained to reflect new
clinical evidence, as well as ``lessons learned'' from their use in the
field. NQF requires that measures undergo maintenance on a three-year
cycle, or sooner if necessary. There is also a critical need to retool
measures to run off of electronic data sources (e.g., EHRs,
administrative data, registries).
Further Strengthen Relationships Between the Quality Community and
the Health Information Technology Community. NQF will foster ongoing
communication and collaboration between the performance measurement
community and the health information technology community, and ensure
proper coordination of standard-setting activities that occur in the
quality community (e.g., standards related to clinical concepts,
performance measure logic, and performance measure specifications) and
standard-setting activities that occur in the HIT community (e.g., EHR
standards for data capture, data transmission protocols).
The goals of this contract will also support key HHS work outlined
in the recently enacted American Recovery and Reinvestment Act of 2009
(ARRA) in three important ways.
Work will support the health information technology (HIT)
provisions of the ARRA by facilitating communications between the HIT
and quality communities to ensure that electronic health records (EHRs)
and personal health records (PHRs) possess the necessary capabilities
to support performance measurement, reporting and improvement. NQF's
work will be of relevance to both of the HIT Policy and Standards
Committees that will be established under this law.
The prevention provisions of ARRA call for strategies to
reduce health care-associated infections and to enhance chronic disease
outcomes. Through the priority-setting process, the NQF contract will
focus performance improvement activities on these areas, and will
identify standardized performance measures that can be used for public
reporting and to assess the effectiveness of these programs.
The comparative effectiveness research program of ARRA
will provide new evidence on what treatments work and do not work to
inform providers and consumers to use the best care available. Through
its priority-setting and endorsement processes, NQF will likely
identify key gaps in the evidence base, and this information will be
shared with the comparative effectiveness program to help guide its
agenda-setting activities.
Conclusion
Health care is going through a period of extraordinary change with
efforts aimed at major reform of the health system. NQF is working
closely with DHHS to ensure that the work under this contract provides
the greatest value and support for health care reform that will give
more people access to high quality, affordable health care.
This new contract will produce tangible benefits that are critical
to establishing the measurement and reporting infrastructure necessary
to achieve broader health reform objectives. Identifying national
priorities for performance improvement, and measuring and reporting on
the performance of health plans, health care providers, and
practitioners against robust uniform national standards, will provide
the needed foundation for achieving better patient outcomes, improved
patient experience, and more affordable health care.
This contract will help establish a comprehensive portfolio of
quality and efficiency measures that will allow the federal government
to more clearly see how and whether health care spending is achieving
the best results for patients and taxpayers, strengthening a core
building block of the nation's capacity to provide high-value health
care.
Appendix A--Report of the National Priorities Partnership National
Priorities and Goals: Aligning our Efforts To Transform America's
Health care (Executive Summary)
The Partners & Acknowledgements
The Partners
Donald Berwick, Co-chair President and CEO, Institute for Health
Care Improvement
Margaret O'Kane, Co-chair President, National Committee for Quality
Assurance
Leah Binder, Chief Executive Officer, Leapfrog Group
Christine Cassel, President and CEO, American Board of Internal
[[Page 46598]]
Medicine Representing the American Board of Medical Specialties
Mark Chassin, President, The Joint Commission
Carolyn Clancy, Director, Agency for Health Care Research and
Quality
Janet M. Corrigan, President and CEO, National Quality Forum
Helen Darling, President, National Business Group on Health
Steven Findlay, Managing Editor, Consumer Reports Best Buy Drugs,
Consumers Union
Roger Herdman, Director, National Cancer Policy Forum and Board on
Health Care Services, Institute of Medicine
Julie Gerberding, Director, Centers for Disease Control and
Prevention
George Isham, Medical Director and Chief Health Officer,
HealthPartners Representing America's Health Insurance Plans
Peter V. Lee, Executive Director, National Health Policy, Pacific
Business Group on Health
Marlene Miller, Vice Chair, Quality and Safety, Johns Hopkins
Children's Center Representing the Alliance for Pediatric Quality
Mark McClellan, Director, Engelberg Center for Health Care Reform,
Brookings Institution
Elizabeth Nabel, Director, National Heart, Lung, and Blood
Institute, National Institutes of Health
Debra L. Ness, President, National Partnership for Women & Families
Frank Opelka, Vice-Chancellor of Clinical Affairs, Health Sciences
Center, Louisiana State University Representing AQA
Alisa Ray, Executive Director, Certification Commission for Health
Care Information Technology
Bernard Rosof, Chair, Physician Consortium for Performance
Improvement
John Rother, Executive Vice President, Policy and Strategy, AARP
Raymond Scheppach, Executive Director, National Governors
Association
Gerald Shea, Assistant to the President for External Affairs, AFL-
CIO
David M. Stevens, Director, Quality Center, National Association of
Community Health Centers
Linda J. Stierle, Chief Executive Officer, American Nurses
Association
Barry Straube, Director and Chief Medical Officer, Centers for
Medicare & Medicaid Services
Richard J. Umbdenstock, President and CEO, American Hospital
Association Representing the Hospital Quality Alliance
Anthony Wisniewski, Executive Director, Health Care Policy, U.S.
Chamber of Commerce
Key Staff
Karen Adams, Vice President, National Priorities
Alicia Aebersold, Vice President, Communications
Nadine Allen, Administrative Assistant
Anisha Dharshi, Program Director
Rebecca Fleischauer, Media Campaign Coordinator
Amy Stern, Senior Director, National Priorities Outreach Efforts
Wendy Vernon, Senior Program Director, National Priorities
Acknowledgements
An undertaking as complex and visionary as setting National
Priorities and Goals for the nation clearly requires much thought, much
expertise, much knowledge, and much work. The Partners first wish to
acknowledge all of the reports and research and all of the efforts of
the commissions and study groups that preceded and informed our work,
many of which the reader can find in the references. We humbly
recognize that our work stands on the shoulders of hundreds of
brilliant people, both from within and outside of the health care
arena, who are working every day to improve the way we deliver care.
They cannot possibly all be listed, but their contributions are more
than significant.
The Partners divided into a number of working groups to accomplish
the work of the Partnership. We wish to thank the following experts who
contributed significantly to our deliberations: Stephanie Alexander
(Premier, Inc.), Carmella Bocchino (America's Health Insurance Plans),
Kent Bottles (Institute for Clinical Systems Improvement), Maureen
Corry (Childbirth Connection), Jay Crosson (Council of Accountable
Physician Practices), Rita Munley Gallagher (American Nurses
Association), Lea Anne Gardner (American College of Physicians), Paul
Gitman (North Shore Long Island Jewish Health System), Trent Haywood
(VHA, Inc.), Richard Hellman (American Association of Clinical
Endocrinologists), Ronald A. Henrichs (American Academy of
Dermatology), Michelle Johnston-Fleece (American Board of Internal
Medicine), Norman Kahn (Council of Medical Specialty Societies), David
Kindig (University of Wisconsin-Madison, School of Medicine), Jerod
Loed (The Joint Commission), Michael Maciosek (HealthPartners Research
Foundation), John Mastrojohn III (National Hospice and Palliative Care
Organization), Kristen McNiff (American Society of Clinical Oncology),
Diane Meier (Center To Advance Palliative Care), David Meyers (Agency
for Health Care Research and Quality), Sean Morrison (National
Palliative Care Research Center), Naomi Naierman (American Hospice
Foundation), Harvey Neiman (American College of Radiology), Marsha
Nelson (American Hospice Foundation), Lee Partridge (National
Partnership for Women and Families), Robert Plovnick (American
Psychiatric Association), Leif Solberg (HealthPartners Research
Foundation), James Tulsky (Duke University, Center for Palliative
Care), Margaret Van Amringe (The Joint Commission), and W. Douglas
Weaver (American College of Cardiology). We wish to thank Michael Lauer
(National Institutes of Health), Brad Perkins (Centers for Disease
Control and Prevention), and Ed Sondik (Centers for Disease Control and
Prevention) for their many contributions to this effort in support of
their respective primary representatives on the Partnership.
We also would like to acknowledge the contributions of National
Quality Forum Members for their input on the determination of the
priorities and their concerted efforts to improve care coordination.
Special thanks go to the chairs of the National Quality Forum Member
Councils, including Paul Convery (Baylor Health Care System), Louis
Diamond (Thomson Reuters), David Domann (Johnson and Johnson Health
Care Systems), David Gifford (Rhode Island Department of Health),
Robert Haralson (American Academy of Orthopaedic Surgeons), Christine
Izui (BlueCross BlueShield Association), Brian Lindberg (Consumer
Coalition for Quality Health Care), and Andrew Webber (National
Business Coalition on Health). Dwight McNeill, Vice President for
Education and Outreach, deserves recognition for his leadership of
these efforts. We wish to acknowledge the input from the following NQF
member nursing associations as well as the broader nursing community:
American Nurses Association (ANA), American Association of Nurse
Anesthetists, American Academy of Nursing, American Association of
Colleges of Nursing, Hartford Institute for Geriatric Nursing, Infusion
Nurses Society, American Organization of Nurse Executives, Hospice and
Palliative Nurses Association, AORN (the Association of periOperative
Nurses), Academy of Medical-Surgical Nurses, American College of Nurse-
Midwives,
[[Page 46599]]
Association of Women's Health, Obstetric and Neonatal Nurses, National
Council of State Boards of Nursing, and the American Psychiatric Nurses
Association. The National Quality Forum staff teams contributed
tirelessly to this effort, led by Karen Adams, Vice President of
National Priorities, and Alicia C. Aebersold, Vice President of
Communications. We wish to recognize the hard work of Nadine Allen,
Ciarra Day, Stacy Fiedler, Sands Hakimi, Sara Maddox, Jeff Patyk, Bryan
Pruitt, Dan Rafter, Mariam Rauf, Leslie Reeder-Thompson, Amy Stern, and
Katharine Torrey. Special thanks to Wendy Vernon and Rebecca
Fleischauer, who did a remarkable job drafting and editing significant
sections of the report. And to Anisha Dharshi for her support of the
working groups and her meticulous proofing of the final report. We wish
to thank Helen Burstin, Senior Vice President of Performance
Measurement for her guidance throughout this process, her service to
the working groups, and her many contributions to the content and
editing of this report.
Thanks also to Suzanne Benoit, Gregg Roby Burrage, Susan Guyre, and
Marjorie Tucker-Pfeiffer at Rings Leighton for their patience and skill
in producing the report, and to the teams at GYMR and MS&L for their
support in the overall effort.
Finally, the National Priorities Partnership acknowledges the
generous support from the Robert Wood Johnson Foundation, whose vision
for the future of America's health care gave us the freedom to imagine
a destination for our nation that is both aspirational and achievable.
We wish to thank Anne Weiss for her invaluable guidance and support for
this initiative and Minna Jung, a communications strategist and guide
of the highest caliber.
Executive Summary
National Priorities and Goals: Aligning Our Efforts To Transform
America's Health Care
The promise of our health care system is to provide all Americans
with access to health care that is safe, effective, and affordable. But
our system as it is today is not delivering on that promise. In recent
years, we have seen remarkable efforts that demonstrate how well health
care organizations can do in delivering on this promise, but these
examples stand out because they are the exception, not the norm. To
improve our results, we must fundamentally change the ways in which we
deliver care, and this will require focused and combined efforts by
patients, health care organizations, health care professionals,
community members, payers, suppliers, government organizations, and
other stakeholders. The National Priorities Partnership--a
collaborative effort of 28 major national organizations that
collectively influence every part of the heath care system--is doing
just that. The Partners, convened by the National Quality Forum to
address the challenges of our health care system, represent multiple
stakeholders drawn from the public and private sectors. These
organizations believe that it will require the work of many to achieve
the transformational change that is needed for the United States to
have a high-performing, high-value health care system. Recent economic
events, including instability of the U.S. economy and what appears to
be a wide and deep recession, make addressing our health care problems
even more urgent. Many Americans have seen their retirement savings
decline markedly, and millions of others have lost their homes and
jobs. It is clear that the health care status quo is unsustainable.
Health care spending accounts for 16 percent of the GDP (gross domestic
product) and is increasing at an average annual rate of around 7
percent. Americans spend more per capita on health care than any other
industrialized country, yet our results on many important indicators of
quality fall significantly below those of similar nations. The time for
serious and transformational change is now. As a first step, the
Partners have identified a set of National Priorities and Goals to help
focus performance improvement efforts on high-leverage areas--those
with the most potential to result in substantial improvements in health
and health care--and thus accelerate fundamental change in our health
care delivery system.
The National Priorities and Goals
The National Priorities and Goals were selected because they
collectively and individually address four major challenges--
eliminating harm, eradicating disparities, reducing disease burden, and
removing waste--that are important to every American. Six Priority
areas have been identified in which the Partners believe our combined
and collective efforts can have the most impact. While the Goals are
aspirational, the success of many small scale improvement projects
offers direction on how we might proceed to bring this to scale
nationally.
Engage Patients and Families in Managing Their Health and Making
Decisions About Their Care
We envision health care that honors each individual patient and
family, offering voice, control, choice, skills in self-care, and total
transparency, and that can and does adapt readily to individual and
family circumstances, and differing cultures, languages and social
backgrounds. The Partners will work together to ensure that: All
patients will be asked for feedback on their experience of care, which
health care organizations and their staff will then use to improve
care. All patients will have access to tools and support systems that
enable them to effectively navigate and manage their care. All patients
will have access to information and assistance that enables them to
make informed decisions about their treatment options.
Improve the Health of the Population
We envision communities that foster health and wellness as well as
national, state, and local systems of care fully invested in the
prevention of disease, injury, and disability--reliable, effective, and
proactive in helping all people reduce the risk and burden of disease.
The Partners will work together to ensure that: All Americans will
receive the most effective preventive services recommended by the U.S.
Preventive Services Task Force. All Americans will adopt the most
important healthy lifestyle behaviors known to promote health. The
health of American communities will be improved according to a national
index of health.
Improve the Safety and Reliability of America's Health Care System
We envision a health care system that is relentless in continually
reducing the risks of injury from care, aiming for ``zero'' harm
wherever and whenever possible--a system that can promise absolutely
reliable care, guaranteeing that every patient, every time, receives
the benefits of care based solidly in science. We envision health care
leaders and health care professionals intolerant of defects or errors
in care, and who constantly seek to improve, regardless of their
current levels of safety and reliability. The Partners will work
together to ensure that:
All health care organizations and their staff will strive to ensure
a culture of safety while driving to lower the incidence of health
care-induced harm, disability, or death toward zero. They will focus
relentlessly on continually reducing and seeking to eliminate all
[[Page 46600]]
health care-associated infections (HAI) and serious adverse events.
Health care-associated infections include, but are not limited to:
Catheter-associated blood stream infections
Catheter-associated urinary tract infections
Surgical site infections
Ventilator-associated pneumonia
(See the Centers for Disease Control and Prevention's Infectious
Diseases in Health Care Settings for a more inclusive list.)
Serious adverse events include, but are not limited to:
Pressure ulcers
Wrong site surgeries
Falls Air embolisms
Blood product injuries
Foreign objects retained after surgery
Adverse drug events associated with high alert medications (See the
National Quality Forum's Serious Reportable Events for a more inclusive
list.)
All hospitals will reduce preventable and premature hospital-level
mortality rates to best-in-class.
All hospitals and their community partners will improve 30-day
mortality rates following hospitalization for select conditions (acute
myocardial infarction, heart failure, pneumonia) to best-in-class.
Ensure Patients Receive Well-Coordinated Care Within and Across All
Health Care Organizations, Settings, and Levels of Care
We envision a health care system that guides patients and families
through their health care experience, while respecting patient choice,
offering physical and psychological supports, and encouraging strong
relationships between patients and the health care professionals
accountable for their care. The Partners will work together to ensure
that: Health care organizations and their staff will continually strive
to improve care by soliciting and carefully considering feedback from
all patients (and their families when appropriate) regarding
coordination of their care during transitions.
Medication information will be clearly communicated to patients,
family members, and the next health care professional and/or
organization of care, and medications will be reconfirmed each time a
patient experiences a transition in care.
All health care organizations and their staff will work
collaboratively with patients to reduce 30-day readmission rates. All
health care organizations and their staff will work collaboratively
with patients to reduce preventable emergency department visits.
Guarantee Appropriate and Compassionate Care for Patients With Life-
Limiting Illnesses
We envision health care capable of promising dignity, comfort,
companionship, and spiritual support to patients and families facing
advanced illness or dying, fully in synchrony with all of the resources
that community, friends, and family can bring to bear at the end of
life.
The Partners will work together to ensure that: All patients with
life-limiting illnesses will have access to effective treatment for
relief of suffering from symptoms such as pain, shortness of breath,
weight loss, weakness, nausea, serious bowel problems, delirium, and
depression.
All patients with life-limiting illnesses and their families will
have access to help with psychological, social, and spiritual needs.
All patients with life-limiting illnesses will receive effective
communication from health care professionals about their options for
treatment; realistic information about their prognosis; timely, clear,
and honest answers to their questions; advance directives; and a
commitment not to abandon them regardless of their choices over the
course of their illness.
All patients with life-limiting illnesses will receive high-quality
palliative care and hospice services.
Eliminate Overuse While Ensuring the Delivery of Appropriate Care
We envision health care that promotes better health and more
affordable care by continually and safely reducing the burden of
unscientific, inappropriate, and excessive care, including tests,
drugs, procedures, visits, and hospital stays.
The Partners will work together to ensure that:
All health care organizations will continually strive to improve
the delivery of appropriate patient care, and substantially and
measurably reduce extraneous service(s) and/or treatment(s).
The recommended areas of concentration are as follows:
Inappropriate medication use, targeting:
Antibiotic use
Poly pharmacy (for multiple chronic conditions; of antipsychotics)
Unnecessary laboratory tests, targeting:
Panels (e.g., thyroid, SMA 20)
Special testing (e.g., Lyme Disease with regional considerations)
Unwarranted maternity care interventions, targeting:
Cesarean section
Unwarranted diagnostic procedures, targeting:
Cardiac computed tomography (noninvasive coronary angiography and
coronary calcium scoring)
Lumbar spine magnetic resonance imaging prior to conservative
therapy, without red flags
Uncomplicated chest/thorax computed tomography screening Bone or
joint x-ray prior to conservative therapy, without red flags Chest x-
ray, preoperative, on admission, or routine monitoring Endoscopy
Inappropriate non-palliative services at end of life, targeting:
Chemotherapy in the last 14 days of life
Aggressive interventional procedures
More than one emergency department visit in the last 30 days of
life
Unwarranted procedures, targeting:
Spine surgery
Percutaneous transluminal
coronary angioplasty (PTCA)/Stent
Knee/hip replacement Coronary artery bypass graft (CABG)
Hysterectomy
Prostatectomy
Unnecessary consultations Preventable emergency department visits and
hospitalizations, targeting:
Potentially preventable emergency department visits
Hospital admissions lasting less than 24 hours
Ambulatory care sensitive conditions
Potentially harmful preventive services with no benefit, targeting:
BRCA mutation testing for breast and ovarian cancer--female, low
risk
Coronary heart disease (CHD): Screening using electrocardiography,
exercise treadmill test, electron beam computed tomography--adults, low
risk
Carotid artery stenosis screening--general adult population
Cervical cancer screening--female over 65, average risk and female,
post-hysterectomy
Prostate cancer screening--male over 75 (From the U.S. Preventive
Services Task Force D Recommendations List)vi
The Path Forward
Identifying a starter set of National Priorities and Goals is a
major accomplishment, but it is only the first step in what must be a
more expansive and ongoing implementation aimed at achieving the
performance goals. Over the next year and beyond, we hope the National
Priorities and Goals will spur action and innovation, because without
coordinated actions, these goals will not be reached. The Partners have
agreed to work with each other and with
[[Page 46601]]
policymakers, health care leaders, and the community at large, to build
on the framework provided in this report, and to develop actions in
each of the major areas that will drive improvements needed:
Performance measurement, public reporting, payment systems, research
and knowledge dissemination, professional development, and system
capacity.
Health care reform is well under way and the current economic
crisis makes solving the puzzles of quality, equity, and value not just
an ideal, but an imperative. The National Priorities Partnership is
encouraging everyone to join not in calling for reform, but in enacting
it nationally and in local communities across the country. The mere
existence of a shared sense of responsibility to meet specific goals
can transform health care quality. Acting to meet them can
revolutionize it.
i. Catlin A, Cowan C, Heffler S, et al., National health spending
in 2005: The slowdown continues. Health Aff, 2007;26(1):142-153.
ii. The Commonwealth Fund, ``Why Not the Best? Results from the
National Scorecard on U.S. Health System Performance, 2008''.
iii. Centers for Disease Control and Prevention, Infectious Disease
in Health care Settings. Available at http://www.cdc.gov/ncidod/dhqp/id.htm.
iv. National Quality Forum, Serious Reportable Events. Available at
http://www.qualityforum.org/projects/completed/srz/fact-sheet.asp.
v. ``Best-in-class'' may be determined by using an accepted
methodology, such as Achievable Benchmarks in Care (ABC)TM.
vi. Agency for Health care Research and Quality, U.S. Preventive
Services Task Force (USPSTF). Available at http://www.ahrq.gov/clinic/prevenix.htm.
The time for serious and transformational change is now.--The
National Priorities Partnership
Appendix B--Report of the Health Information Technology Expert Panel:
Recommended Common Data Types and Prioritized Performance Measures for
Electronic Health Care Information Systems (Executive Summary)
As described in the Institute of Medicine's (IOM's) Crossing the
Quality Chasm report, the quality of health care in the United States
is substantially lacking in many pivotal areas. Complex care is
typically uncoordinated, and important information is frequently
unavailable when needed by providers. Consequently, unexplained
variations in the delivery of health care and the underuse, overuse,
and misuse of health care products and services pervade the system,
compromising the quality of American medicine and jeopardizing the
health of its recipients.
Measuring quality is a first step toward improving American health
care. Currently, however, collecting and reporting accurate,
comparative health care performance data is complex and largely a time-
consuming, manual process. Quality improvement leaders have long
recognized that the widespread adoption of health information
technology (HIT) will automate and simplify these processes by
providing electronic information. Yet, to date, most of the electronic
health information readily available for quality measurement has been
administrative, claims-based data, which include only limited clinical
information.
Electronic health record (EHR) systems have been identified as a
fundamental HIT tool for collecting high-quality electronic clinical
information. The federal government and private sector leaders have
increased efforts to expedite and encourage the widespread adoption of
HIT by health care providers; yet significant barriers prevent the
collection of needed quality information within the EHR. To compare
performance nationally, all quality indicators need to measure the same
concepts and speak the same language in order to consistently and
reliably measure quality.
Although there is no dearth of HIT standards, such standards do not
exist when defining quality metrics (e.g., the definition of diabetes
may be interpreted differently by different institutions). This lack of
a set of precisely defined, universally adopted clinical definitions is
an obstacle to measuring and comparing quality.
To address the need for standardization of health care quality
measurement, the American Health Information Community (AHIC), an
advisory committee to the Secretary of the Department of Health and
Human Services (DHHS), established a Quality Workgroup to define how
HIT can evolve to effectively support performance measurement. The
workgroup recommended that an HIT expert panel be convened in order to
accelerate ongoing efforts in this standardization process. The
National Quality Forum (NQF) was commissioned by the Agency for Health
care Research and Quality (AHRQ) to assemble and convene the expert
panel and to provide a detailed account of its conclusions and
recommendations. The NQF Health Information Technology Expert Panel
(HITEP) members (Appendix A) were selected to ensure broad
representation across the fields of quality measurement and HIT and of
EHR vendors, health systems, and government organizations. With the
goal of achieving automated quality measurement, the panel was charged
with the following tasks:
1. Establish a priority order for the current sets of AQA
Alliance--and Hospital Quality Alliance--approved measures;
2. Identify common data types from the subset of highest priority
measures to be standardized for automation in EHRs and health
information exchanges; and
3. Develop an overarching quality measure development framework to
facilitate developing, using, and reporting on quality measures from
EHR systems.
To prioritize measures for immediate attention, the panel used the
IOM's priority conditions. Next, the panel identified the common data
types (e.g., outpatient diagnosis, laboratory result, medication order)
required by these high-priority measures. The panel then developed a
set of criteria (e.g., level of data standardization, accuracy of data
source) to assess the quality of each data type as it currently exists
in EHRs. Each data type received a summary quality score from these
criteria. Because measures are composed of numerous data types, the
panel calculated overall scores for each measure as the average quality
of its individual data types. This overall measure score can be used to
assess a measure's readiness for EHR implementation and to focus
efforts to improve (or replace) low-scoring measures and low-scoring
data types. Although the work of HITEP was to establish an initial
prioritization of measures and their associated data types, further
data types should be identified as additional priorities and measures
are developed.
A key product of the HITEP meetings, a list of common data types
(i.e., diagnoses, laboratories, medications), was submitted to the
Health Information Technology Standards Panel (HITSP) for the selection
of standard terminologies, or code sets (i.e., ICD-9, LOINC, SNOMED),
to express these data types. These computerized terminologies,
identified in the HITSP Quality Interoperability Specification version
1.0, will support efforts for universal adoption of standardized
performance measures in EHRs. Active engagement of standard development
organizations by HITSP will aid in closing the gap between the quality
and information technology enterprises. Additional
[[Page 46602]]
recommendations for EHR functionality will be submitted to the
Certification Commission for Health Care Information Technology (CCHIT)
for consideration in future certification criteria.
HITEP identified three broad requirements to improve the quality
measurement information technology enterprise and suggested
recommendations to CCHIT, HITSP, measure development organizations
(MDOs), NQF, EHR vendors, and the HL7 EHR Technical Committee. First,
quality measures should be designed to leverage the capabilities of
EHRs. MDOs and NQF should work together to reinforce the use of high-
quality data types during measure development and endorsement of
measures into consensus national standards. Second, standard
terminologies should be identified to code the common data types used
in quality measure definitions. Finally, quality measure clinical
information should be accurately captured in EHRs. Quality and
information technology stakeholders should work with EHR vendors to
develop functional criteria for software needed to capture the common
data required for quality measurement.
Appendix C--Overview of the Tasks of the Contract
The contract consists of twelve tasks. The first five tasks involve
overall contract management and include the development of a work plan
and an internal quality assurance evaluation plan. A detailed work plan
for the first year of the contract activities is under way. Tasks six
through twelve represent the work of the contract. A brief synopsis of
each task is provided below.
Task 6: Formulation of National Strategy and Priorities for Health Care
Performance Measurement
NQF will 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. NQF
will develop a framework for measure prioritization that will take into
account the cost and prevalence of the conditions and the likelihood
and ease of measurement to improve the quality, value and transparency
of the performance of the health care system. This framework will
identify those areas where no measures currently exist and will assist
key stakeholders with the prioritization of those areas in which
measure development may be required. NQF is currently developing a
request for proposal to select a subcontractor, and under the guidance
of NQF, will develop the framework and other documents that will assist
with identifying critical measurement gap areas as well as prioritize
those areas through endorsement of measures, reworking existing
measures and/or measure development. This prioritization framework will
help guide the future work of this contract and measurement priorities.
Task 7: Implementation of a Consensus Process for Endorsement of Health
Care Quality Measures
NQF is a voluntary consensus standards-setting organization and has
an established multi-stakeholder consensus development process to
endorse measures appropriate for public reporting and quality
improvement. The process involves seven steps specifically designed to
develop consensus among diverse stakeholders: Formation of a steering
committee, calls for measures, measure evaluation, public comment,
member voting, review by the consensus standards approval committee and
board of directors, and appeals. This process has been streamlined to
better meet the needs of the health care industry. Using this process,
NQF has endorsed more than 400 quality measures for a variety of health
care settings. As part of this contract with DHHS, NQF will endorse
measures and measure sets. These measures will focus on specific
conditions and settings as well as across episodes of care.
Task 8: Maintenance of Consensus Endorsed Measures
As an endorsing body, NQF is responsible for maintaining
endorsement of the consensus standards. Due to evolving research and
implementation issues, measure maintenance is required by NQF every
three years. This established process along with annual updates of the
measure specifications ensures the relevancy of the endorsed measures
to current health care practice. The ability to critically examine the
measures on an ongoing basis with built-in requirements for regular
measure maintenance provides a critical avenue to ensure that the best
measures are available for public reporting health care performance and
quality improvement.
Task 9: Promotion of the Electronic Health Records (EHRs)
EHRs have significant potential to improve the quality,
coordination, and efficiency of patient care. In the context of
performance measurement and improvement, they also have a critical role
to play in collecting chart level clinical patient data, which may be
reliably used in performance evaluation. The objective of this task is
for performance measures to have turnkey measurement specifications
that allow for ready incorporation directly into EHRs; and for EHRs to
capture the necessary data and possess the necessary functionality to
calculate and report the performance information and to provide the
associated clinical decision-support to practitioners to improve
performance. To achieve these goals, there needs to be ongoing
communication and collaboration between the performance measurement
community and the health information technology community. NQF is
planning to convene these groups to streamline the performance
measurement enterprise and to promote the use of EHRs to achieve the
quality improvement goals of DHHS.
Task 10: Annual Report to Congress and the Secretary of the U.S.
Department of Health and Human Services
This report will provide an update as to the progress of the tasks
associated with the contract. NQF will use a structured system for data
gathering and reporting, and on a monthly basis, will gather
information for inclusion in the final report. The annual report will
be available on the NQF Web site for public viewing after copies are
submitted to the Secretary and to Congress.
Task 11: Development of a Public Web Site for Project Documents
NQF will provide electronic access on a public website to all of
the project's final and revised reports, standard operating procedures
for consensus-building and maintenance procedures, and working
documents deemed necessary as part of their consensus-building
processes for any and all tasks issued under this contract. Planning is
underway for Web site layout and the Web site will ``go live'' in June
2009.
Task 12: Focused Measure Development, Harmonization, and Endorsement
Efforts To Fill Critical Gaps in Performance
NQF is prepared to address measurement gaps identified in Task 6 of
this contract in a timely, efficient, and effective manner. NQF will
respond to up to ten requests annually to fill critical gap areas
through measure endorsement, measure harmonization, measure
restructuring, and measure development. NQF will subcontract with
established measure developers to develop new measures, including
composite measures and/or re-working
[[Page 46603]]
existing measures to fill critical gaps in measures of health care
performance.
National Quality Forum, 601 Thirteenth Street, NW., Suite 500
North, Washington, DC 20005, Fax 202-783-3434, http://www.qualityforum.org.
III. Secretarial Comments on the Annual Report to Congress
The Secretary is pleased with the scope and vision of NQF's March
2009 annual report. The contract with this consensus-based entity, NQF,
provides a unique opportunity to further enhance HHS' efforts to foster
a collaborative, multi-stakeholder approach to increase the
availability of national voluntary consensus standards for quality and
efficiency measures to ensure broad transparency in achieving value in
health care delivery. An internal multidisciplinary cross-component HHS
team is working collaboratively with NQF to ensure a clear multi-year
vision to ensure the most efficient and effective utilization of the
HHS contract. HHS looks forward to the ongoing opportunity to
collaborate with the broader health care community as part of this NQF
contract to ensure a consensus-based national strategy and priority
setting process for health care measurement focusing on high-quality,
patient-centered, efficient health care delivery.
IV. Future Steps
The consensus based contract with NQF is a four year contract.
During the first year of the contract, NQF shall complete deliverables
for each task. HHS will task NQF with single year and multi-year
projects.
Formulation of National Strategy and Priorities for Health Care
Performance Measurement
During the first year of the HHS contract, NQF will create a
framework for measurement prioritization by conducting an environmental
scan of at a minimum, the 20 patient conditions that account for over
95% of costs to the Medicare program. NQF is establishing a steering
committee to oversee the prioritization process.
Maintenance of Consensus Endorsed Measures
During the first year of the HHS contract, NQF is maintaining
endorsed measures relevant to HHS-wide programs and will be maintaining
consensus-based endorsed measures as developed under the priority
process.
Promotion of Electronic Health Records
During the first year of the HHS contract, NQF is supporting the
promotion of electronic health records and quality measurement
incorporation as part of HHS-wide efforts.
Focused Measure Development, Harmonization, and Endorsement Efforts to
Fill Critical Gaps in Performance Measurement
During the first year of the HHS contract NQF is supporting a
variety of performance measurement efforts including, but not limited
to, the areas of efficiency, harmonization, outcomes, patient safety,
care coordination, ICD-10, palliative care, and nursing home quality
metrics.
The public is encouraged to give input through the NQF process and
will be able to track the progress on work related to this contract on
the NQF Web site located at: http://www.qualityforum.org/projects/ongoing/hhs/.
V. 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).
Dated: September 3, 2009.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
[FR Doc. E9-21783 Filed 9-4-09; 4:15 pm]
BILLING CODE P